Tests – what are they good for?
In the realm of back pain tests, of
MRIs that question must be examined. What are MRIs good
for when the percentage
of constructive, influential MRI studies is so little?
False positive MRI results upset those who receive
these results. They inspire fear or caution where it
is not always needed. MRIs like this blur the
proper treatment plan. They spend a lot of money.
Paulette Hugulet, DC, LLC carefully evaluates the necessity of
MRI in the La Grande chiropractic treatment plan of La Grande
back pain relief.
Interpretations of MRI images by
radiologists often differ.
The true-positive finding rate was 56.4%, and the miss-rate was 43.6%. (1)
MRI imaging may trigger misleading suspicion. When
following the guidelines of the American College of Radiology, 93% of lumbar
spine MRIs were appropriate. Of those, only 13% uncovered
anything suspicious. Of the 36 MRIs that roused
suspicion of cancer or infection, 81% were false-positive. 59% of the follow-up
MRIs on those suspicious findings were false positives. (2) MRI imaging may mislead.
For example, MRI demonstrates that the appearance of
disc degeneration in asymptomatic persons – persons with no back pain – increases
with age: 37% in 20 year olds and 96% in
80 year olds; disc bulges: 30% to 84%; disc protrusion: 29% to 43%; annular
fissures 19% to 29%. These imaging findings indicate that
these are signs of normal aging. They remind all doctors, remind chiropractors
like yours at Paulette Hugulet, DC, LLC, to correlate all such
findings with patient symptoms. (1,3) Your La Grande
chiropractor does this!
Choosing Wisely guidelines for American chiropractors recommend
not repeating spinal imaging and not getting spinal imaging for
patients with acute low back pain in the first 6 weeks of back pain (unless there
are “red flags” – issues that suggest
something more worrisome). (4) A review of the efficacy
of the Canadian Choosing Wisely recommendations for imaging nonspecific spinal
pain and symptoms stated that there is very low risk of missing
a serious cause of back pain. (5) The goal
of guidelines is less imaging, fewer false positives. Paulette Hugulet, DC, LLC wants what is
best for our La Grande chiropractic care patients.
COX® TECHNIC’S VIEW
Chiropractors like yours at Paulette Hugulet, DC, LLC study
all the symptoms, tests and images our La Grande chiropractic back
pain patients [[present on|bring with them39] their first La Grande
chiropractic visit. So many back pain patients present to
Paulette Hugulet, DC, LLC with MRI images already done.
Paulette Hugulet, DC, LLC will look at them but will depend more
on clinical exam findings and link them to what the MRI reveals.
A rule of thumb with the Cox Technic System of Back Pain Relief is to work
toward 50% decrease of back pain in the first month
of care before ordering more imaging or
testing or referring for surgical consultation. (6)
CONTACT Paulette Hugulet, DC, LLC
Listen to this PODCAST
with Dr. Dan Clark on the Back Doctor’s Podcast with Dr. Michael Johnson as he explains
the role of imaging for back pain in the scheme of treatment
for pain relief.
Schedule your La Grande chiropractic appointment
with Paulette Hugulet, DC, LLC today. Let us discover together
the best path to La Grande back pain relief – with or without MRI