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MRI for back pain pros n cons comic

Paul Ingraham ARCHIVEDMicroblog posts are archived and rarely updated. In contrast, most long-form articles on are updated regularly over the years (see updates page).

This is brilliant:

Comic by Patrick Lyons of Coogee Bay Physiotherapy.

“I don’t know how else to proceed,” LOL! A couple years after graduation from massage therapy school, a (well-trained!) colleague called me up and said, “I really just have no idea what to do with back pain patients. Can we try to figure this out together?” (And that’s when I started studying chronic low back pain seriously, one thing led to another, and I accidentally wrote a book about it. 😃

Not every reader is going to fully appreciate the humour in the doctor’s thoughts. I’ll explain some examples that some might find cryptic:

What’s a “bottom up understanding of back pain,” and why’s that bad? It’s the idea that back pain comes primarily from backs (bottom up), when in fact we have really strong evidence that back pain severity and chronicity is powerfully by the brain (top down).

Greater disability scores associated with MRI utilization.” One of the most common ways of measuring the badness of back pain is “disability” as determined by a very carefully designed questionnaire. And disability gets worse (higher scores) when MRI is involved in the assessment of back pain, probably because it “medicalizes” and dramatizes. This is a nocebo effect (opposite of placebo). Basically, looking for things wrong with people’s spines makes people fear their spines, which makes them more hesitant. MRI also almost always finds problems that look bad but aren’t actually significant, which of course is even more of a problem. MRI is nearly useless for most back pain.

Reduced sense of well-being following exposure to MRI.” Very similar to the previous item! “Well-being” can be high even when you have a bunch of back pain … or it can be low. When back pain is over-medicalized — too much fancy diagnosis, scary treatment options bandied about — people feel worse about their situation. More worried! Understandably.

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