You may choose to come yourself, or you may be referred to see an orthopedic spine surgeon for relief of your neck or back pain. Your pain is a significant concern, but the cause of your pain is often unclear. You may bring an MRI scan already ordered by another doctor, assuming that the reason for your pain is obvious on the scan. Or, if you have not had an MRI, you may believe that you need one to solve your pain problem. Will an MRI show your pain?
Pain is something that you feel but that we cannot measure. MRI scans show details of spinal anatomy; unfortunately, they do not “light up” and show the source of pain. Your MRI does not show your pain. Most MRI scans show what we refer to as “degenerative changes.” These are the natural result of being human and getting older and are equally present in people who have spine symptoms and those who don’t. Studies show that by their 40s, 25% of people with no pain will have degenerative changes on MRI scans; by their 60s, 75% of people with no pain will have degenerative changes on an MRI. Therefore, the presence of a “disc bulge” or “bone spur” on your MRI does not automatically explain your pain. It may simply verify that you are getting older!
Spine specialists refer to a “pain generator” as the likely source of pain. For example, a broken bone can be reasonably assumed to explain pain. However, for most patients, the cause of neck pain or back pain is not as obvious. Possible pain generators in the spinal area include bones, discs, joints, ligaments, muscles or nerves. Some pain in the neck or back may even be referred from internal organs and not be from the spine. For example, a kidney infection may be felt as back pain.
The diagnosis of a “pain generator” is largely based on the medical history – what you tell the doctor when he asks questions about your pain: when it started, how it started, where you feel it, does it go down your arm or leg, what increases or decreases the pain, and what may have been helpful in managing the pain. A good and careful history will narrow the options and guide the next steps of solving your pain problem.
After taking a good history, the spine specialist will perform certain physical examination maneuvers to help refine the impression gained from the history. After the examination, the likely source of your pain is usually known or the choices narrowed to a short list of possibilities. At this point, some testing may be needed to begin helpful treatment; sometimes tests are not needed. Your doctor can then explain the diagnosis and offer you options to help you feel better.
If you do have an MRI scan, please make every effort to be sure the spine specialist can look at the actual pictures, rather than just the written report. Spine specialists are trained to assess various details that may not be mentioned in the report.