An MRI will reassure me...

People who report with pain want to know what is causing it. People need to be reassured. This is particularly more prominent when people suffer pain surrounding the spine, particularly neck and low back pain. It doesn't matter how much your clinical tests can establish the reason for pain, there are some who do not believe until they have seen it for themselves. I have blogged a lot on low back pain and recently I have blogged about the necessity for reassurance in the rehabilitation of low back pain, you can read this here:

If they know what is going on inside their bodies, then they'll be happy".

When truth be known, is having the MRI scan going to change the treatment outcome? The only way this can be answered yes, is if there is a need for surgical intervention. Once you explain that to patients, they usually answer with a resounding NO to wanting surgery. So why the need for an MRI for reassurance? Ravesteijn et al (2012) researched into this. They conducted a systematic review of the evidence thus far. They intended to establish whether imagery reassured patients, in addition whether imagery had an influence on symptoms and ability levels.

There review highlighted just seven articles into this subject. They were not just interested in MRI's. The studies looked into ECG, blood tests, X-ray and MRI. It may come as a surprise that their review identified that there is no significant difference in reassurance by offering imagery! This result was not a surprise to me, however what was a surprise was that the reviewers identified research by four of the seven articles that showed an increase in symptoms following imagery results!

This was the same for both pain and lack of ability. I can only hypothesise that because imagery will show something is wrong, people start to worry even more about the innocuous changes going on inside them that they start to worry about these too! It doesn't stop there!

The researchers also established that there was no significant difference with regards to patient satisfaction! It must be said, that owing to the low number of articles available that it would be unfair to conclude that imagery causes more harm than good. There was some good news though

A significant difference in reassurance was noted in pre-explanation. In other words, if the clinician spent time with the patient beforehand, explaining the likely cause of pain and that changes on an MRI are like an older perosn getting grey hair. Changes on an Image are normal. This showed greater reassurance due to increased patient-clinician relationship. As I have blogged before: Imagery does not always equal harm. What this evidence can elude to is that imagery has the potential to create more anxiety than reassurance. Article: Ravestein et al (2012) "The reassuring value of diagnostic tests: A systematic review. Patient Education and Counseling. 86 pp: 3 - 8. Article available as a hard copy or pdf at request.