Should You Have an MRI for Your Back Pain?

MRIs are powerful but can lead doctors on a wild goose chase. At what point should your doctor take a look inside your back with a high-tech MRI or CT scan, or even an old-fashioned X-ray? In most cases, the answer is later rather than sooner.

The rap against MRIs as a diagnostic tool for low back pain is not that the scans usually reveal nothing, or even that they’re expensive, it’s that they often show a lot of abnormalities in the back that may have nothing to do with the source of your pain. With aging, the hard-working spine begins to show signs of wear and tear, such as degeneration of disks and arthritis in joints. But for a pain condition that in most cases resolves itself in less than two months without dramatic intervention, that kind of information isn’t particularly helpful.

MRIs do not expose your body to radiation. But CT scans and X-rays do, which make them especially risky for women with lower back pain who are in their childbearing years.

When do imaging tests make sense?

It can be a good idea to get an imaging test right away if you have signs of severe or worsening nerve damage, or a serious underlying problem such as cancer or a spinal infection. “Red flags” that can alert your doctor that imaging may be worthwhile include:

  • A history of cancer.
  • Unexplained weight loss.
  • Fever.
  • Recent infection.
  • Loss of bowel or bladder control.
  • Abnormal reflexes, or loss of muscle power or feeling in the legs.

Your doctor might recommend an MRI if he or she suspects that your low back pain is caused by something more serious than muscle strain. This may be the case if:

  • Your history and physical examination show signs of a serious problem, such as a fracture, tumor’s, infection, or nerve damage.
  • You are older than 70. Your doctor may also recommend testing if you are older than 50 and also have osteoporosis or a history of compression fracture.
  • You have had osteoporosis for a long time or you have diabetes.
  • Your body’s defense system (immune system) is not able to fight infection.
  • You have a history of long-term steroid use or a history of a drug problem.
  • You have a history of a previous spine injury or back surgery.
  • You have symptoms related to compression on a certain nerve root or roots.
  • Back pain has not improved after at least 6 weeks of home treatment that may include pain relievers, heat or ice, and exercises.