Insight to Action

​When Pain (and the MRI) Lies

9 February 2016

We hear a lot about "unnecessary care" driving health costs, but how do we judge what is unnecessary? Although it's common to focus on people reporting symptoms, another way to do it is to study what healthy people look like, so we can establish what "normal" is.

A recent study published in the American Journal of Neuroradiology showed that "normal" (asymptomatic) adults with no reported back pain nevertheless have a high prevalence of related abnormalities visible in their MRIs. The same herniated disc "requiring" surgery in one patient could be a painless, normal feature of aging in another patient. This confirms what many clinicians informally say – a high percentage of back surgeries are unnecessary, and don't address the true cause of the reported pain. The result is an expensive procedure compounded by a dissatisfied patient who is still in pain.

This doesn't mean surgeons are the bad guys: when patients visit a surgeon, the surgeon's job is to treat the patient using the information and tools they have. This is why it's essential to have a holistic approach to care management, and it's how coordinated care models save money and get better outcomes.

Bottom line: "rationing" care is not as important as "right-sizing" care.