Is My MRI Abnormality the Cause of My Pain?
I recently retired from my faculty position as a musculoskeletal radiologist at Duke University Medical Center after reading over 60,000 MRI scans of the spine and joints in the past 36 years. Now, as an online coach for clients with pain and inflammatory conditions I find myself having to answer this question quite often. Fortunately, there have been 3 decades of research devoted to this topic which has revealed some surprising and unexpected findings.
Musculoskeletal MRI has evolved dramatically from being an experimental technique when I published some of the first papers on MRI of the knee in 1986 and MRI of the shoulder in 1989 to become the gold standard for non-invasive diagnosis depended on by general practitioners and specialists alike. Unfortunately, this powerful imaging method has sometimes been misused, and the abnormalities have been given undue significance in many cases.
It is important to recognize that MRI is so sensitive that it detects the changes of normally expected aging in the spine and joints, often with impressive clarity. These appearances can be quite alarming for patients, many of whom now have access to their electronic medical records and even the actual images themselves. People will often point to their MRI scans and make the premature assumption that they have found the cause of their pain.
Between 1990 and 1995 a series of MRI studies were done of the lumbar spine, cervical spine, knee, and shoulder in asymptomatic volunteers showing abnormalities on up to half of the scans. Radiologists and surgeons have been aware of this conundrum for several decades which led one of my neuroradiology colleagues to add a disclaimer to every spine MRI report saying that the findings are of uncertain clinical significance.
A large systematic review of 33 articles evaluating 3110 lumbar MRI or CT scans in asymptomatic volunteers showed that abnormalities increased linearly with age. Comparing 20 year olds to 80 year olds, disc degeneration increased from 37% to 96%, disc bulges increased from 30% to 84%, disc protrusion increased from 29% to 43%, and disc annular fissures increased from 19% to 29% like the findings in the MRI pictured above.
However, if you do have symptoms an MRI may provide important information to exclude other more serious conditions. When it shows a clearly significant abnormality such as a tumor, infection, inflammation, or fracture your healthcare professional can use these findings to guide your surgery or other treatments. An acute injury should improve within a couple months. If pain persists beyond that point you’ll need to dig deeper to find the cause.
So, if you have new onset of low back pain and your MRI just shows one or more of the findings of aging, how should you respond to this diagnostic information? Could the abnormality have been there already before you developed the symptoms? If the symptoms persist will surgery improve the situation? Is there any other mind-body-spirit explanation for your pain that could be addressed with safe and inexpensive self-healing techniques?
Possible answers to these dilemmas are detailed in my blog Is Chronic Pain All in Your Brain? The latest research on pain using fMRI brain scans has revealed the existence of learned neural pathways that are part of a psychophysiologic disorder involving repressed emotions such as anger. There are a variety of approaches to unlearn your pain, but my favorite is EFT tapping which I use in my coaching program along with hypnosis and dreamwork.
The same concerns with aging changes on MRI also apply to cervical spine disc abnormalities as well as knee meniscal tears and shoulder rotator cuff tears. For pain in these areas it is sometimes useful to consider the symptoms as somatic metaphors for emotional blocks that may be revealed in dreams. Another symbolic approach is to evaluate the chakra energy centers of the body for shadow issues relating to imbalances due to childhood trauma.
I will be addressing pain due to anger imbalances in the 2nd chakra in a Transforming Symptoms of the Lower 4 Chakras in Physical Illnesses post conference intensive that will be live streamed at the Baltimore ACEP conference on 6/5/23. For a more in-depth exploration of these issues I am offering my annual Tapping into Health course at Duke Integrative Medicine on Thursdays in May for the 6th time, but it will be the first time in a hybrid format with both in-person and Zoom options.