TORONTO - Fewer than half of MRIs ordered to look for the cause of lower back pain are appropriate uses of the imaging machines, a new Canadian study suggests.
In fact, only about 44 per cent of MRIs ordered for the lumbar spine were appropriate, the study found. The rest were deemed to be either inappropriate or of questionable value. Lead author Dr. Derek Emery said "inappropriate" in this case means unlikely to benefit the patient.
Emery said the study, which was published Monday in the journal JAMA Internal Medicine, was undertaken because there is a suspicion in medical circles that a lot of ordered MRIs are actually a waste of the resource and of the patient's time.
"There's a lot of talk out there and it's even mentioned in the literature that a lot of imaging is used inappropriately. Or a lot of imaging is unnecessary. But this has really not been rigorously studied," said Emery, a neuroradiologist in the faculty of medicine and dentistry at the University of Alberta.
Cutting back on unnecessary MRIs would help pare long waiting lists for access to the costly machines.
"MRI's a limited resource in most of Canada. Certainly it is in Alberta. And if we can eliminate some of the unnecessary scans, that will give us capacity to scan more patients who really need it," Emery said.
The study was done by researchers from the University of Alberta, the University of Calgary, the University of Toronto, and the Ottawa Hospital Research Institute.
They looked at MRI orders for two conditions — lower back pain and recurrent headaches — from the University of Alberta Hospital and the Ottawa Hospital. A panel of experts studied requisitions as they came in, assessing the appropriateness of 500 from each institution for each procedure. They used an existing nine-point scale for measuring appropriateness.
They also looked at who was doing the ordering, assessing how well different medical specialties were doing when it came to requisitioning appropriate MRIs. The acronym stands for magnetic resonance imaging, a type of scan that is particularly useful for soft tissue imaging.
Family physicians had the lowest rate of appropriate MRI orders for lower back pain, with only about one-third of the scans they requisitioned qualifying as appropriate. Neurologists and orthopedic surgeons were better, but were still under 50 per cent.
MRIs for the lumbar spine ordered by neurosurgeons were appropriate three-quarters of the time. But Emery noted neurosurgeons generally order MRIs for problems after surgery, when it's clear there may be an issue. They are not doing the basic sifting of lower back pain cases that other types of doctors are doing.
When the group studied the use of MRIs for recurrent headaches, they found a different story. Just over 80 per cent of ordered MRIs were deemed to be appropriate. That may be because most of the people who had MRIs for headaches were essentially pre-screened, having already undergone a CT scan, Emery said.
The research was funded by the Canadian Institutes of Health Research.
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8 Foods That Fight Pain
Turmeric For Muscle Pain
According to previous research, turmeric is more effective in tackling pain relief and inflammation than steroid medications. According to researchers from the<a href="http://www.nih.gov/" target="_hplink"> National Institutes of Health</a>, the pain relief properties from turmeric are more prevalent to <a href="http://www.nhs.uk/conditions/Rheumatoid-arthritis/Pages/Introduction.aspx" target="_hplink">rheumatoid arthritis</a> sufferers, as it inhibits the destruction of joints from arthritis. Turmeric contains a protein called NF-kB, which, when turned on, activates the body's inflammatory response, which helps battles aches and pains.
Red Grapes For Back Pain
Red grapes are packed full of resveratrol, a powerful antioxidant compound that blocks enzymes that degenerate tissue damage, which can lead to joint and muscle pain. According to the <a href="http://www.rush.edu/" target="_hplink">Rush University Medical Center</a>, resveratrol helps protect against cartilage damage that causes back pain in particular. Another study by the <a href="http://www.msu.edu/" target="_hplink">Michigan State University</a> found that cherry extract is ten times more effective than aspirin when it comes to relieving inflammation in the body. Other berries rich in back-pain fighting resveratrol include blueberries, cranberries and blackberries.
Ginger For Knee Pain
Ginger is well known for its ability to block the pain-causing prostaglandin levels in the body. Ginger has long been used as a natural method of pain relief, particularly in India, where researchers regularly test its inflammation and pain relief properties. According to research by the <a href="http://www.miami.edu/" target="_hplink">University of Miami</a>, researchers discovered that two third of patients with chronic knee pain reported less soreness after taking a daily dose of ginger extract for six weeks. Health experts recommend a daily dosage of 500 to 1,000mg of ginger a day to help ward off aches and pains.
Soy For Joint Pain
Research by the <a href="http://osu.okstate.edu/welcome/" target="_hplink">Oklahoma State University</a> found that osteoarthritis sufferers who consumed 40g of soy protein a day for three months, reported a 30% improvement on their arthritis-related knee pain. Soy contains bundles of <a href="http://www.isoflavones.info/" target="_hplink">isoflavones</a>, a plant hormone with strong anti-inflammatory properties, which helps reduce the discomfort of osteoarthritis and other related joint pains.
Salmon For Neck Pain
Omega-3 fatty acids are crucial for keeping the immune system healthy - and warding off inflammation and chronic neck pain. During research at the <a href="http://www.pitt.edu/" target="_hplink">University of Pittsburgh</a>, 60% of participants experienced enhanced pain relief from eating more fish or taking fish oil supplements for three months. The effect was so great, almost as many stopped taking their daily pain relief as a result. Besides salmon, other fish that contain high levels of the essential EPA and DHA omega-3 fatty acids include halibut, tuna, trout, mackerel and sardines.
Cherries For Arthritis
Cherries, like the other members of the berry family, contain high amounts of antioxidants called anthocyanins - the key compound to the cherry's pain fighting power. According to research by the <a href="http://www.agriculture.gov.ie/" target="_hplink">Department of Agriculture</a>, participants who ate 45 big cherries daily for 28 days reduced their inflammation levels significantly. Researchers found that cherry anthocyanins are especially effective in treating arthritis symptoms, as participants of the study said their joint pain had improved as a result of consuming cherries or cherry juice. Anthocyanins contain antioxidants, anti-inflammatory and anti-diabetic properties.
Coffee For Post-Workout Pain
If you ever wondered why over-the-counter painkillers contain caffeine, it's because coffee enhances the effects of common pain relief. It also acts as a natural pain reliever itself, particularly good for post-workout aches and pains. Researchers from the <a href="http://www.uga.edu/" target="_hplink">University of Georgia</a> discovered that patients who drank two cups of coffee after working out, reduced common post-workout aches and pains by almost 50%. Experts also claim that caffeine is good for a pre-workout boost too, as it has been proven to raise the body's pain threshold.
Sage For Sore Throats
The humble sage is commonly used to treat throat ailments, like tonsillitis, mouth ulcers, gum disease, laryngitis, as well as other problems like headaches, bruises, bad memory and common menopause symptoms. Sage contains rosmarinic acid, which is absorbed into the body and acts as an anti-inflammatory agent, which soothes inflamed muscles. Add it to boiling water and make your own sage tea, or sprinkle it as a seasoning on your food.