From: sbharris@ix.netcom.com (Steve Harris  sbharris@ROMAN9.netcom.com)
Newsgroups: sci.med,sci.med.cardiology
Subject: Re: Can MRI diagnose the cause of intractable lower-back muscle pain?
Date: 17 Oct 2003 11:53:02 -0700
Message-ID: <79cf0a8.0310171053.68156332@posting.google.com>

pfriley@watt-not.com (PF Riley) wrote in message
news:<3f8f73f3.2495254@news.nwlink.com>...

> On Wed, 15 Oct 2003 12:38:29 -0400, M_un Over Seattle
> <NoETOH@email.com> wrote:
>
> >On Wed, 15 Oct 2003 16:31:16 +1000, "Peter Jason"
> ><paul@colonel.com.au> wrote:
> >
> >>I have had this for a long time.
> >
> >Possibly, it will depend on the cause.  For instance, LBP can be
> >associated with kidney pathologies. If the MRI does not image the
> >kidneys, or the radiologists misreads the MRI looking at the spine
> >instead, well, you get the drift.
>
> The answer is that the MRI will most likely either show nothing
> abnormal or it will show that his back muscles hurt, which he knew
> already.


COMMENT:

Or it shows some pathology like a possible compression from a possible
old or new disk extrusion, or possible narrowing of foramina due to
this or that. All of which are common in middle aged people with no
pain, and none of which helps very much in deciding what to do with
the average person with moderate back pain.

If the symptoms from the back are so severe that the question is not
WHETHER to cut, but WHERE, then MRI can be helpful. That's cases where
somebody is dragging a leg or foot, or in such severe pain even on
narcotics that after a few months they're still a basket case, and
could not possibly wait the 12 months it takes for the effectiveness
of surgical treatment and drug treatment of back pain to come out
equal (as they do at one year).

But 95% or 99% of back pain that is MRI'd, doesn't qualify. For those
people, the procedure is a either a complete waste of money, or else
it's worse than a waste, helping to promote a surgery which wouldn't
have been done on purely clinical grounds (ie, from signs or symptoms
like weakness or really severe pain).

If I we had all the money that has been wasted these last 15 years on
MRIs for back pain or syncope, etc, we'd have enough $ to bail out
Iraq and California, built two new space shuttles, and still have
enough left over for a free box of Kleenex for all Cubs fans (hundreds
of them!). A couple of guys just won the Nobel prize for inventing
MRI, but the machine is only as good as the users. In this case, the
whole technology reminds me a little of what Heller says in Catch 22
about the military: it's a mechanism invented by geniuses, and run by
morons.

SBH

From: sbharris@ix.netcom.com (Steve Harris  sbharris@ROMAN9.netcom.com)
Newsgroups: sci.med,sci.med.cardiology
Subject: Re: Can MRI diagnose the cause of intractable lower-back muscle pain?
Date: 17 Oct 2003 21:01:58 -0700
Message-ID: <79cf0a8.0310172001.59669b56@posting.google.com>

J <PhilOMatH@example.net> wrote in message
news:<3F904201.EFBE672A@execulink.com>...

> "Steve Harris sbharris@ROMAN9.netcom.com" wrote:
>
> > If the symptoms from the back are so severe that the question is not
> > WHETHER to cut, but WHERE, then MRI can be helpful. That's cases where
> > somebody is dragging a leg or foot, or in such severe pain even on
> > narcotics that after a few months they're still a basket case, and
> > could not possibly wait the 12 months it takes for the effectiveness
> > of surgical treatment and drug treatment of back pain to come out
> > equal (as they do at one year).
>
> Does such (dragging a leg - actually he intermittently has no feeling
> from the knee down) resolve in a year w/o surgery?
> J


COMMENT:

Maybe, but generally nobody dares find out. It's pain-only that the
results mentioned above apply to.

SBH

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med
Subject: Re: Can an MRI be Misleading?
Date: 27 Jun 2005 12:19:48 -0700
Message-ID: <1119899988.919257.299580@g47g2000cwa.googlegroups.com>

>>I had an MRI showing a disc prolapse at l4/5 level... it did not say,
nor did the doctor say, if it was pinching my nerve... <<


Yeah, so?  Often you can't tell from an MRI, because there are plenty
of people with disc prolapses and no symptoms. So, you wasted
(somebody's) money. That's an old story.

The MRI is helpful as an aid to tell the surgeon where to cut in
patients who've *already* decided to have back surgery based on
clinical symptoms and findings and nerve conduction studies. But the
MRI is a very poor diagnostic tool in evaluating back and leg pain,
being neither sensitive nor specific. And it is horribly expensive.
Neverlessless, the temptation to use it is almost overwhelming. What a
horrible waste of resources.

And how many people have gone uselessly and fruitless under the knife
for back pain, because of the pretty pictures the damn MRI machine
spits out?  Argghhh.

SBH

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med
Subject: Re: Can an MRI be Misleading?
Date: 27 Jun 2005 22:01:35 -0700
Message-ID: <1119931495.960950.63290@g44g2000cwa.googlegroups.com>

>>Well, the MRI was given to me for precautionary measures, I was
complaining about tingling in my perinium and pain in my UT... <<

As a precautionary measure?? You wanna have your back whittled on for a
tingle in your groin?

Here's what happens. You do an MRI for this, and see nothing. You docs
say: "Hmm, we don't see any cause for his tingling perineum."

Or, you do an MRI for this, and you see a herniated disk or spinal
stenosis. And your docs say "Hmm, that could be the cause of his
tingling perineum!  But we wouldn't cut unless it was a lot worse....."

SBH

From: Steve Harris <sbharris@ix.netcom.com>
Newsgroups: sci.med
Subject: Re: Can an MRI be Misleading?
Date: 4 Jul 2005 14:03:53 -0700
Message-ID: <1120511033.927549.219610@g44g2000cwa.googlegroups.com>

>Steve Harris wrote:
>> And how many people have gone uselessly and fruitless under the knife
>> for back pain, because of the pretty pictures the damn MRI machine
>> spits out?  Argghhh.
>
> So why is it that when:
>   "You let the people with the problem and the market decide."
>
>Things don't seem to work out so well?
>
> Maybe we need some government intervention here to protect these
>poor folks this unnecessary surgery.
>Marty


COMMENT:

We wouldn't, if they *paid* a big hunk out of pocket for the surgery in
the first place!  If they did, they'd put it off, and put it off, like
they do their major dental procedures and major car repairs, and lots
of other stuff people are reluctant to spend a lot of money on. After a
while, their backs wouldn't hurt so badly, and they'd realize they'd
just saved themselves a lot of dough due to application of that magical
stuff we doctors call Tincture of Time.  It would be a lot like
Canada's long waiting list for back surgery, except it would run itself
with no bureaucracy!  Think of it as "Invisible Hand Chiropractic (TM)"


If you look at randomized treatment of simple back pain with disk
herniation by surgery vs. "conservative management" (ie,
symptomatically with physical therapy and painkillers) you find that
after a year there's no difference in outcome. But a lot of
disappointed surgeons and radiologists and people who sell and own MRI
machines.

SBH