"Oh, My Aching Wallet"
A recent article was published in the Washington Post discussing the costs of an MRI vs. physical therapy regarding low back pain. Not surprisingly, individuals who were referred directly to physical therapy saved on average $4,793 as opposed to the group requiring an MRI. What are the reasons behind the cheaper costs?
One of the biggest reasons behind the increased costs of an MRI is the patient's fear associated with benign findings. An MRI will detect all 'pathology' of the spine: disc herniations, degenerative disc changes, and more (I use the term 'pathology' lightly because more and more research is confirming that these changes are a natural part of aging). In many instances these findings are not the cause of a patient's pain. As Julie Fritz, PT, PhD points out in the article "most people older than 40 or 50 have it [DDD] to some degree." These previously unknown findings scare patients to seek additional more expensive treatment.
Another reason behind the high amount of referrals for MRI is a physician's financial interest. The article states that the average MRI cost $1000-$1500 and many insurance companies will reimburse the expense. Evidence has shown us that an MRI is not an appropriate intervention for low back pain, unless the patient presents with specific signs and symptoms. As Fritz states "there is a place for advanced imaging. It is just not early in the course of care for most patients."
What can we do?
1) Educate our patients! MRIs continue to be ordered because public perception is still permitting it. We need to educate our patients that an MRI is likely not the solution to their problem. Educate the patient regarding the aging spine. For example, I tell my older patients that disc degeneration is extremely common and that these changes can be thought of as internal gray hair. They are an inward sign of aging. Additionally, I educate them that benign changes are common in healthy individuals as well. One's acute episode of pain was likely not due to chronic arthritic changes.
2) Educate yourself. A key component of my residency training at the Harris Health System was pain science education. We spent several lecture sessions discussing the relationship between our patient's symptoms and their MRI/X-ray findings. As a profession, we now know more about the brain and it's response to pain than ever before. Make sure you are staying on top of the literature regarding the benefits and risks of imaging.
4/11/2015 01:50:13 pm
Question: I understand the rationale behind this topic, however how does that relay to the treatment of a patient that presents to you in clinic with an RX for tx of DDD/OA or stenosis or spondylolisis? At times theses patients do not have the "textbook symptoms" and sometimes feel relief with positions such as extension that technically are contraindicated. Would you proceed with recommended treatments for such diagnosis or treat based on presented symptoms even if there is a specific DX?
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