If you’ve ever visited your doctor with lower back pain and were ushered into a high-tech MRI scan conveniently located on-site… you may have already spent too much for your back pain treatment.
Does an In-office MRI machine lead to better back pain care?
According to a comprehensive Stanford University review of over one million episodes of back pain care, MRI usage skyrockets as soon as doctors obtain the ability to bill directly for MRI scans, whether from purchasing a machine or contracting with another facility.
According to Dr. Laurence C. Baker who authored the study, “In the first quarter after they began billing, orthopedists jumped from using about 20 more MRIs per 1,000 episodes than traditional users to using about 45 more. Neurologists jumped by more, increasing their rate by about 60 to nearly 140 procedures per 1,000 episodes more than traditional users.” (emphasis added)
Guess what… before they started to bill for MRIs directly, these same doctors’ patients had similar lower rates of use as other physicians who never started direct billing. The jump only happened after they got the machine — and the new higher rates persisted.
So what’s the deal here? Are doctors simply ordering more tests because of the convenience factor, or are doctors merely padding their wallets?
Dr. Baker thinks it could be both, including in his report that “reimbursements could greatly exceed the costs of acquiring and operating the equipment, making the services potentially quite profitable.”
Yeah, to the tune of $25-$91 more per visit averaged across all visits for those with MRI machines.
But here’s the real question: does the increase in tests ordered translate into better quality of care?
NO. Especially among back pain sufferers.
First of all, MRIs are notorious for showing problems in your spine that don’t actually cause pain. In a study of 98 pain free people, MRIs showed that nearly two-thirds of them had either a bulging or herniated disc!
Which goes to show that an abnormal reading from an MRI may not be the source of your back pain — or any pain at all.
Plus, patients of orthopedic surgeons who acquired MRI machines were far more likely to undergo back surgery within six months of their visit than patients of doctors who did not direct bill.
Yet back surgery is such a pathetic back pain treatment that it’s the ONLY surgery with its own clinical name for failure: failed back surgery syndrome.
Far too many surgeons are putting their patients through an expensive revolving door of tests, dangerous drugs, and surgery only to leave them crippled for life with excruciating pain.
It’s clearly time to take a different approach to back pain. One that focuses on the underlying causes instead of operating on a condition showing up on a test that may have nothing to do with your pain in the first place.
I’m not going to say an MRI is never called for. But it’s pretty clear even to doctors like Dr. Baker that buying a hammer sure makes every problem look like a nail.
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References
Baker LC. Acquisition of MRI equipment by doctors drives up imaging use and spending. Health Affairs (Project Hope). 2010 Dec;29(12):2252-9.
Jensen MC, et al. Magnetic resonance imaging of the lumbar spine in people without back pain. The New England Journal of Medicine. 1994 Jul 14;331(2):69-73.
Jesse, I just had an MRI. Haven’t heard from the doctor yet, but I did see an xray of my neck showing degenerated discs. I am having episodes across my shoulders and in my arms, so felt I needed to have it seen about. Give me your thoughts on degenerating discs, please. I have had surgery in my lower back for the same problem. I was in a study for a Dynesis procedure. It has worked pretty well, but I would like to avoid further surgery if possible. Can degenerated discs be reversed? I have read about your program, but haven’t convinced my husband to buy it just yet. We are both retired and are cautious about spending money, especially over the internet having not personally visited with you. Thank you for your time.
Linda Wallace
Linda, I’m not a doctor and have no 1,000 patient results behind me, so do your own research to validate what I say and see a medical practitioner experienced at helping people regrowrejuvenate bone and connective tissue with natural rather than by means of drugs.
If I were in your shoes I would start eating foods and taking supplements that directly supported natural healing of bone and connective tissue.
1. Cut out milk and milk products like cheese and eat more wild Alaskan salmon and less meat. From my book:
“Yale University researchers recently analysed 34 studies from 16 countries and found that the countries with the highest rates of osteoporosis (USA, Sweden and Finland) were those whose populations consumed the most meat, milk and other animal based products. On a country by country basis, those who consume the most calcium intake have the weakest bones and highest rates of osteoporosis.”
2. Increase your intake of foods that contain vitamin K2. Again, from my book:
“Vitamin K2 helps prevent bones from breaking down and helps calcium absorption by the bones. A Japanese study found increasing consumption of vitamins D and K more beneficial than Calcium for increasing bone density.
“Magnesium and strontium have also been proven to help increase bone density and strength. 60 years ago there was 5 times the magnesium in our diets compared to today. Other important bone benefiting nutrients are Boron, Copper, Iodine, Manganese, Silicon and Zinc.
“Natural progesterone combats osteoporosis and other symptoms of estrogen dominance.
“DHEA also helps increase bone mass density.”
3. I started getting some pain in my right knee. It has disappeared since I started taking a supplement containing the following:
Glucosamine sulfate potassium chloride complex 1g (1000mg), equiv. to Glucosamine sulfate 750mg, Chondroitin sulfate (shark) 400mg, Ascorbic acid (vitamin C) 50mg, Manganese 2mg (as amino acid chelate).
4. Eliminate inflammation causing foods like simple carbs (bread, cakes, flour and sugar) and adopt a paleo diet. Search Paleo on Google.
Hope this helps and good luck.
I had blown out my knees on a 16 story construction site. My knees just started to swell and where very painful to even stand at all. My doctor scheduled me to see a “specialist” in sports medicine. He sent me off to get MRI’s and had an in office Xray’s done. We went over the both results andhecshowed me the tear in this and ther wear on that joint and I ate it like candy. He did a bilateral knees surgery and I have been crippled since that operation. I was forced to retire and when another doctor looked at my original test results he said he could find nothing wrong with my knees that therapy could not have solved. I was crushed to hear this, but I failed to ge a second or third opinion. Thec surgeonthat did this was fired and made to leave. My knees were still pumped full of painkillers and they were wearing off slowly , but I was not even allowed to see this doctor fo referal or anything. I got a call years ago from some lawyer that wanted tostart a class action suit,but I declined. I wanted him be punished for unneeded surgery, not pad the pockets of some Ambulance chaser.
This full article is becoming a major point in my arguement with Workers Compensation – who for 7 years has denied me access to specialists and medications, rehab programs etc due to an MRI showing Annular tear in one location without buldging or herniated discs.
I have no pain referred from my spine and 2 specialists hve run several tests proving that fact.
Injury incurred at work.
Workers Comp has blamed degenerative discs and lumbar facet joint syndrome identified from MRI for my pain which is there 24/7.
Unfortunately my injury is a sciatic nerve stretch/tear and soft tissue tear in the pyriformis muscle.
An injury Worker Comp finally Jun 2011 admitted to me as having incurred during tactical retesting for my ERT team position. Now at a desk job my back is getting worse.
Thank God for MRI and a neurosurgeon that found my problem and operated. I was in severe pain for three long months to the point I couldn’t stand long enough to take a shower without throwing up, due to a herniated disc pressing on my sciatic nerve. I had spinal injections, physical therapy, and lots of pain meds. that didn’t help. Eating right and taking supplements might help prevent these problems but without the surgery, I know I would still be living in hell. I had the surgery at an outpatient center, walked out a couple hours later with no pain and have been pain free for over a year. There will always be doctors and people taking advantage for profit but there are also those who really take pride in helping people using the tools they have.
Linda what surgery did you have, I have been suffering the same pain for 2 years now and have tried everything but surgery. I tried many different programs that claimed you would be pain free from their program. They usally put me in more pain. I have been scared to get surgery, because of all the bad things you hear about it for back pain. But I think at this point I am out of options. It would be nice just to get a full nights sleep, instead of waking up every hour from the pain.
Linda ..you are absolutely right some surgeries that help. More aoftyen than not I see them done for profit and to try and help the patient. They are not going to refer them out to me so I could get them well if they have a chance to make several thousand dollars. MRI’s are not that conclusive. There are errors, false positives, that result in needless surgery and false negaitves that result in misdiagnosis. I avoid using MRI’s sine my examination and thorough history is enough to let me know if we are dealing with a disc herniation or not.
Unfortunately, many people are not referred to chiropractors or acupuncturists who can help most of these people. I have been using Inversion Therapy quite successfully in combination with Chiropractic spinal adjustments & educating my patients on avoiding bending over, prolonged sitting the use of home therapies like ice/heat etc. When I first suggest inversion many people are hesitant but once they understand that gravity compresses the spine and disc most when sitting or bending forward and that inversion reverses that compression and actually reverses and sucks the herniation back in it makes sense and they are willing to try anything to avoid surgery. Once they are upside down 98% of my patients state they feel no pain while inverted.
My husband had bad back and leg pains and had an MRI showing a bulging disc at the L4 and L5. We canceled back surgery twice and he had spinal decompression with a chiropractor. His back and leg pain disappear. Treatments were costly but worth it (around $4k to $5k). However now he is having problem with persistent pain in his testicles, occasional bladder infections (his PSA test was normal). We researched and think they are early symptoms of cauda equina (another variation of bulging dics impact which will require surgery). He is scheduled for surgery on Feb 22. Anybody has experience with these symptoms and surgery, please advise us. Thank you.
Hello, My name is Mark, I had my L4-L5 disc ruptured . I had the surgery to have the disc removed which left me with around 40% of my disc. I can only offer you this advice. Take it easy . don’t lift anything more than a can of soup for the first 2-3 weeks, Don’t turn or pivot at the waist. Turn using your feet. Stoop down to pick things up. Be very guarded of the way you move. Before my surgery I was a 30 year old walking with a cane stooped over because of the severe pain, MY right leg from my hip down felt like someone hot took a hot poker and jammed down the inside of my leg.If I felt like I had to urinate I only had about 1 min. to find a restroom before I would go on myself. I even started to look older. My best friend since elementary school stated I looked 50+. The day of my surgery I was at the hospital at 6am. I was on the table by 7:30 .At 11:45am I was in the recovery room. I knew where I was by around noon. I had to stay over night because I was sick due to the anesthesia. I must say though that as soon as I was settled in the bed at the hospital,I had no more pain. I will say that for 98% of the time I don’t have any pain. I am also weaker in my back than I use to be. I was able to lift around 125lbs from the ground. Not no more,50 lbs is about it. My surgery only consisted of having partial disc remove. No bones being fused or any thing else. I am know 41,Doing normal everyday activities . I drive a semi truck for a living ,i am on the road for one to two weeks at a time. Good luck.
Have had an ache in my lower back for years
Have tried 3 chiropractors, physical therapy and acupuncture with no success.
In my research I have come across what may be an answer for me and others.
It is the North American Spine Institute in Dallas.
With a 1/4 inch incision at the base of the spine and inserting a high def camera and
a laser, they can see and correct just about anything anywhere in the lumbar area.
Compared to open back surgery, recovery time is miniscule.
Hope this helps us.
Had surgery on Feb 31st (based on a MRI) and I can say am pain free for the first time in 8 months of suffering.
Luis what surgery did you have and when. How was your recovery?
Hi Jason,
It seems that my first comment is still awaiting moderation. On that one I commented that I tried everything before commiting to the surgery. To make a long story short, I dealt with sciatica for about 11 months. Pain made my life miserable and I did everything I could to try to avoid surgery. I am in pretty good shape with a strong core, did a lot of yoga, pilates, spinal decompression, 3 epidrual injections, bought Jesse’s book, etc. I decided to do a microdiscectomy on Jan 31 and since then have been pain free. Post operative is not a big deal, first 4 days I had some back pain but nothing to die for. Actually they prescribed percocet for pain but I didn’t take it and instead used arnica montana pellets (homeopathy)
If you have any question regarding the surgery do not hesitate to ask.
Cheers
I had to laugh and then cry when I read your article. I’ve been for 5 MRIs in the last month and a half. Started with my sciatic nerve pain. Then sent for lower lumbar MRI. When reviewing that one, doctor said I had “hyperreflexia” or exaggerated reflexes and wanted me to go for both thoracic and cervical MRIs next. After nothing was found on those, referred to Neurologiesst. Neurologist sent me for two more MRIs, one more cervical with contrast (dye) and one of brain to ensure no lesions. Nothing found…and thousands of dollars later. Oh, forgot to mention, that after the brain MRI received a disturbing voicemail that said the brain scan came back fine but I had MS. Then after calling in to confirm that I hadn’t misunderstood the voicemail, I later got an urgent vmail back from the Neurologist saying she was so sorry that there was a misinterpretation of her notes and I did not have MS! I could not even believe that they can leave thoese results on your cell voicemail. I wouldn’t want to be told I had MS on my voicemail. I guess I’m just grateful to not have MS and to be controlling my sciatia pain with non-surgical methods! Thanks “lose the back pain”!
Luis,
I have suffered with back pain, muscle spasms, sciatica, degenerative disk disease, ostioarthritis, etc and do not want surgery or have to take pain medication if I can avoid it, I have excercised and been fairly active most of my life, have no other problems but mainly back, what type of physician do I need to see for relief?
Anne, I have reviewed your contact record and I see that you have the 7 Day Back Pain Cure Book, I think there is a lot of information in the book that can directly help you and your condition, do you have any questions about the book and how it can help you and your condition?
Now as for which Dr to see, if you want to see a MD and the Orthopedic are most peoples first choice and if you are looking to have work done, The Chiroproactor again is a top choice…
Now I will say that the 7 Day Back Pain Cure book was written to help you understand the issues that Drs do not cover and to help you make your own decisions about your own back… as the biggest problem that most people have is that they go to a Doctor and they are told what to do never knowing why they are doing what they are told to do and with out the why, our will and desire fade, that is why we teach you the why so you understand what you are doing and make the most of it…
And that is a much better way to support your own back
Steve
I have been suffering from sciatica for the last year, it had gotten so bad that my legs have been hurting immensely and in the morning it was hard for me to walk, I had been going to a chiropractor for therapy 3 times a week, My doctor and Chiropractor wanted me to get an MRI, so he would know what discs needed to be worked on. I brought the MRI results back to him and he told me he couldn’t help me any more, my mri showed that I had a herniated and bulging disc, but the problem that he couldn’t help was that It showed spinal stenosis as well and he told me I would need back surgery, I just had a steroid epideral injection that has helped relieve the pain I was feeling. Is this true that I will need back surgery to fix this problem? I just want this pain to stop.
Hi Jill,
Thank you for your comment and questions. We would like to help and suggest that you please read our back pain book. If you click on the link it will take you to a page where you can learn more about it.
https://losethebackpain.com/products/7-day-back-pain-cure-book
Essentially it will help you to understand the back and you will have a better understanding of all of your options when it comes to treatment, in addition to other useful and helpful advice. Do please read all of it before you make your decision.
Thank you
Admin (THBI)
I woke up one morning with excruciating pain in my buttocks, left leg and back of my knee pain. Thinking I had twisted wrong, I exercised, walked and continued like this for a couple weeks. I then went to my doctor and she said it was sciatica and gave me exercises to help it. It didn’t help and so she had x-rays done showing I have osteoarthritis and sent me to physical therapy. (it is now going on 4 weeks). In pt for the first week I was put on the stretch table and within the week I was unable to move without tremendous pain. Again I returned to the doctor and she said that sciatica takes time to go away, prescribed meds and more exercises and two more weeks of pt. Going on four months and the pain was so intense that I couldn’t even comb my hair, raise my arms, stand for any length of time, walk, etc. without vomiting, crying, or being able to obtain a few hours sleep.
She finally sent me for an MRI and it revealed a ruptured disc with a small fragment that had broken off and was wedged against the sciatic nerve. I went to a neurosurgeon, he explained everything about the surgery, pros and cons, including not having it done and relying on meds and the hope it would go away. He also said that after surgery it could happen again because my bones are so fragile…but it would happen again with or without the surgery.
I had the surgery one week later. It has now been 6 weeks, I am totally pain free, have undergone 3 weeks of physical therapy and am very careful of my movements. It can take up to a full year for total healing but I am now on the road to having my life back.
I have learned alot about exercising every day. I purchased the healing back program and do exercises and walk two miles every day. My nutrition has changed to improve my bone health as well.
I know that without the MRI and a good doctor, I would not be functioning today. Please do not be afraid of possibly having surgery. Do your research on the procedures and get second and third opinions…this is so important. And even if you are in pain, try to stay active…this does help.
Also, a comment on the K2 response above this one. I researched it and K2 is contained in milk, eggs and dairy products as well as meat and chicken legs. So I am confused as to why the response to the questions was to cut out these foods when that is where we can get this wonderful vitamin naturally???? This is from a USDA website “Foods Rich in Vitamin K2”. I also googled several over websites, all saying the same thing. K2 also is supposed to combat coronary heart disease and possibly lower the risk of prostate cancer.
Thank you for reading this and I hope it helps someone make the right decisions. I know its difficult and we are all different in our pains, but please do your research!
They can’t scam me on the MRI. I have a pacemaker and can’t have one.
I graduated in the year 1957. Went through intensive experience in Government hospitals and Private Medical Practice. I must have seen and noted many things. Just because patients have the utmost trust in the sayings of their doctors instead of the doctors being careful not to betray that trust, there are some who for reasons and agendas of their own, indiscriminately prescribe MRI. It is wrong! To capitalize on another’s suffering for self-indulgences is wrong! To look at another human being as a member of the human family, one’s family member, Gods family, and so give off the best that which in the watch of God will cause to attract His bounties; must be the way “Work is Worship, Service is Prayer” practiced!
I’ve been dealing with back pain since 2006 been to all kinds of drs got shots MRIs therapy I have pain down back of both legs but right one is more severe have numbing tingling hot sensation in right leg only don’t want surgery but seems like that’s the last remedy to fix my problem any other ideas on a fix for me I’m tired of the pain
Hi Rita,
Thank you for your comment and we would like to help. Please consider getting yourself a copy of our book, “The 7 Day Back Pain Cure”.
The book discusses back pain and related conditions including sciatic pain, pain relief methods, treatment options and much useful health-related information as well when dealing with pain. We consider education to be a key element in understanding back pain and the book is a useful resource and a good starting point to help you consider what is right for you.
Please read more about the 7 Day Back Pain Cure book and details of what it covers via the link below
https://losethebackpain.com/products/7-day-back-pain-cure-book
Our Best Wishes, Thank you
Admin (The Healthy Back Institute)