What happens when an MRI report makes the patient feel worse?

What happens when an MRI report makes the patient feel worse? What are the benefits of “clinical reporting”? Results from an RCT and blinded studies

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The use of MRI in assessing low back pain (LBP) has led to a higher incidence of surgery every year, with significant complications such as mortality and a 19% cumulative increase in reoperations. MRI utilization accounts for 22% of the variability in spine surgery rates, more than twice accounted for by patient characteristics. However, MRI can produce a nocebo effect, as radiologists report on images without clinical knowledge of the patient, causing the patient and surgeons to feel that intervention is required for the spine to become normal. Inappropriate use of MRI in LBP evaluation has been discussed, but its negative influence on the patient remains a concern.

This study1 aims to evaluate the impact of routine MRI reports on patients’ perception and treatment outcomes, devise a clinical method for avoiding fear-inducing words, and conduct a blinded study to assess the effect on spine condition perception and healthcare provider decision-making.

 

The global burden of Lumbar Spinal Pain (LBP) is increasing, prompting a call for action from nations and governments. The increasing use of MRI has been a significant cause of the conversion of LBP symptoms into a disease that requires intervention and surgery. MRI use accounts for 22% of the variability in spine surgery rates, and the variability accounted for the difference in patient characteristics. However, 50% of MRI requests for LBP are inappropriate and an economic drain.

This study demonstrates the nocebo and harmful effects of an MRI report on LBP patients and healthcare providers. Patients in Group A were more likely to perceive their back condition, pain severity, and functional outcome as serious, leading to anxiety and catastrophization of the disease. The negative perception of spine damage can lead to the persistence of pain and inadequate response to treatment.

Patients uncertain of their health seek opinions from patient peers and the Internet, leading to increased anxiety, symptom severity, distress levels, functional impairment, and increased healthcare utilization. This can lead to a strong association between advanced spine imaging and a three to four times increase in the rates of lumbar spine surgery.

The influence of an MRI report on patients and healthcare professionals (HCP) extends beyond the patient to include orthopaedic surgeons, residents, and physiotherapists. Clinical reporting significantly affects these professionals, as they perceive lesser severity of the disease, prescribe conservative treatment, and assess lower surgery probability. Spine surgeons, however, are more reliant on MRI reports for educating patients about their spinal condition.

The study highlights the deleterious effects of routine MRI on medical professionals, medicalizing LBP into a spinal disease. Clinicians must use MRI wisely, only requesting imaging to confirm diagnosis when an intervention is planned. Radiologists should adopt ‘clinical reporting’ and avoid catalogue-like descriptions of image changes.

Adopting responsible MRI usage and clinical reporting can reduce the unnecessary effects of low back pain. The study calls for a conceptual shift in how advanced imaging is used in LBP and a plea to move from ‘image reporting’ to ‘clinical reporting’. This will help reduce the unnecessary spending on lumbar spine surgery and improve patient outcomes.

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