MRI No Help in Treating Lower Back Pain with Steroid Injections

Magnetic resonance imaging does not appear to help patients slated for epidural steroid injections (ESI) for chronic lower back pain, and has only a minor effect on the physician’s decision making, according to a study published online this week by the Archives of Internal Medicine.

Lower back pain is the world’s leading cause of disability, and one of the top three reasons people seek medical attention, according to the report by a team led by Steven P. Cohen, MD, of The Johns Hopkins School of Medicine.

Despite several studies demonstrating that advanced radiology does not improve outcomes in patients with lower back pain - with or without symptoms such as nerve irritation causing pain shooting down the back of the leg - the use of MRI in this context continues to soar, Cohen and colleagues wrote.

“The lack of unequivocal guidelines on the use of MRI before ESI is somewhat unexpected, considering that ESI is the most frequently performed procedure in pain clinics throughout the United States,” they wrote.

The team conducted a multicenter randomized study in which the treating physician in group 1 patients was blinded to the MRI results, while the physician for group 2 patients decided on the treatment after reviewing the MRI findings. For the patients in group 1, an independent physician proposed a treatment plan after reviewing the MRI, and that plan was compared to the treatment the patient actually received. A total of 132 patients (average age 52, of whom 34 percent were taking painkillers) were randomized into the two groups. Group 1 patients all received ESIs. Not all patients in group 2 received ESIs, if the MRI finding did not support that treatment, at which point the patients exited the study.

A month later, group 2 had slightly lower pain scores than the MRI-blinded patients in group 1. But the differences had evaporated at three months, the researchers reported.

“In conclusion,” the authors wrote, “our results suggest that although MRI may have a minor effect on decision making, it is unlikely to avert a procedure, diminish complications, or improve outcomes. Considering how frequently ESIs are performed, not routinely ordering an MRI before a lumbosacral ESI may save significant time and resources.”