In medicine we quite frequently place too much emphasis on diagnostic imaging (x-ray and MRI) results. Many times we are quick to use these findings in order to make a diagnosis and explain the reason for pain or dysfunction. This approach to diagnosis and treatment may lead us astray from the true cause of our pain and may result in sub-optimal treatment. In fact, Orthopedic Surgeon Gordon Waddell discusses in his book, The Back Pain Revolution, that single signs and symptoms are unreliable in diagnosing back pain and a more accurate diagnosis can be made using a combination of key signs and symptoms.
Besides the fact that diagnostic imaging may be misleading, it may actually result in poorer outcomes. Waddell indicates that overall, patients who underwent x-rays as part of the diagnostic process for low back pain reported higher levels of pain and poorer general health status at 3 months. He goes on to discuss the fact that repeat x-rays resulted in more distress and poorer mental health than any physical indicators. This means anxiety about x-ray findings can actually be more disabling than the symptoms themselves. Even more concerning is the fact that diagnostic imaging may result in unnecessary and costly surgery that is not beneficial to the patient.
The main points to takeaway from this discussion are: there is a time and a place for diagnostic imaging and findings from these studies should not be used in isolation to make a diagnosis. Health care professionals should follow evidence-based guidelines to determine when x-rays and MRI’s are warranted and when they aren’t. It is the health care practitioner’s responsibility to determine when imaging may aid in diagnosis and when it may detract from patient care. When imaging is indicated and performed, health care practitioners must correlate findings with signs and symptoms discovered during a thorough patient history and clinical examination. Diagnosis and development of a plan of care in this manner will lead to more effective treatment and resolution of symptoms.