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Sticks and Stones May Break My Bones and Diagnostic Labels Can Hurt You

That is probably the worst nursery rhyme ever, but hopefully it got your attention.

We have previously discussed in other blogs some of the pitfalls of MRI’s, specifically for low back pain. To summarize:

  • MRI reports are unreliable

    • In a study, they had a woman with a history of low back pain go to 10 different MRI facilities. There was not 1 diagnostic finding that was found on all 10 reports. Almost a third of the findings were found on only 1 report.

  • Clinical guidelines advise MRI’s on the spine only if there are “severe or progressive neurological deficits (numbness/tingling and weakness), suspect serious underlying conditions (ie; cancer)”, or if you are considering surgery

    • MRI’s are so detailed that they will pick up any problem. These problems may have been present for years, may not be causing your pain, and may fix themselves

  • MRI’s are so detailed that there are many false positives… meaning the MRI report demonstrates that there is a problem, when really there is not

    • A study of people in their 20’s found that 37% had “spinal degeneration,” and 30% had a “bulging disc”. However, none of these people had back pain.

    • In those over the age of 80, 96% of reports found spinal degeneration and 84% disc bulge. And again, none of these individuals had back pain

  • Studies have shown that people with back pain who got an MRI early on, had on average a worse prognosis than those who did not

Now there is evidence supporting that the diagnostic labels that are given to a patient with back pain from MRI’s and other imaging studies have large implications on their recovery.

Diagnostic labels are things like: arthritis, disc bulge, degeneration.

I have found myself many-a-time, defending someone against the diagnosis they were given. And I don’t blame them. We all want answers. We all want to know exactly what is wrong with us, so we can fix it. Here’s the problem. The label is harmful and not helpful.

These diagnostic labels are a nice ribbon put on the worst wrapped box you have seen. Pain is SO complicated. To claim the exact pain you are experiencing is due to this one thing is just not true.

Not to mention, those labels have been shown to be harmful to recovery in this recent study by O’Keeffe et al. It included 1,375 participants with and without back pain. Participants received one of six labels: “disc bulge”,degeneration”,arthritis”,lumbar sprain”,non-specific low back pain (LBP)”, “episode of back pain”. The outcome that was measured was their belief about the need for imaging.

Those given the labels “episode of back pain”, “lumbar sprain”, and “non-specific LBP” had higher recovery expectations and lower ratings of need for a second opinion, surgery, perceived seriousness, and need for imaging studies (MRI/x-ray) compared to the labels “arthritis”, “degeneration”, and “disc bulge”. These differences were even larger among those with current low back pain and those who had a history of seeking care.

The label matters. I hope that as more and more medical providers become familiarized with these studies that they will think twice about labeling and the implications it can have on someone’s health and recovery. If you are unfortunately faced with a label like “degenerative disc disease” or something else, I hope this helps you understand the limitations of the imaging studies that create these labels.

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