Early magnetic resonance imaging (M...

Early magnetic resonance imaging (MRI) for gentle back pain might lead to rapid diagnosis and effective treatment, on the other hand it also may identify abnormalities unrelated to the patient's symptoms. Jarvik and colleagues course of lifeed a randomized trial that compared richnesss benefits, and patient outcomes with radiography versus MRI as an initial diagnostic touchstone in patients with low back pain.

The authors recruited 380 eligible patients. After completing questionnaires related to pain and functional status, patients were assigned randomly to radiography or MRI of the lumbar spine. Certain patients, as it is as those for whom additional views had been ordered, were exclud from the trial. The primary issue measure was the modified Roland back pain disability scale, which measures the force of back pain on activities of daily living. This scale was administered three six, and 12 month after imaging, with the hypothesis that patients who received MRI would have better scores than those diagnosed by dint of radiography. Secondary outcomes included back pain oftenness and bothersomeness according to the Medical issues Study 36-Item Short Form Health contemplate Preference scores and time--trade-off technique measures were assessed. The authors also guarded an economic analysis that included office visit expenses alternative health care consultations, medication use, hospitalization, back-pain-related time, and transportation.

The research was completed by 167 participants in the MRI cluster and 170 in the radiography form into groups There was no statistically significant difference between the collections in the 12-month Roland scale score. The radiography assemblage had a score of 875 compared with a score of 934 in the MRI cluster Both groups had significant clinical improvement, especially in the first three month with no significant differences between assemblages according to many measures. The satisfaction score relating to the standing of reassurance patients received from imaging, however, differed between the assemblages with patients consistently rating reassurance from the MRI outcomes higher than that for the radiography arises although this difference was small. At 12 month 58 percent of those receiving radiography versus 74 percent of those receiving MRI replyed that their test results reassured them.

Patients randomized to radiography had approximately twice the total number of physical therapy, acupuncture, massage, osteopathic, or chiropractic appointments, whether initiated at physician or patient, compared with the MRI form into groups Because more MRI patients underwent surgery the costliness of care was higher in the MRI assign places to although this difference was not statistically significant. In expressions of cost-effectiveness, MRI is more gorgeous than radiography with clinically equivalent issues but there appears to be wide variation. Therefore, it is difficult to make definitive statements about the economic imports of these different imaging approaches.

Overall, MRI be deriveded in no improvements over radiography in metes of disability, pain, or general health status. Patients and physicians preferr MRI. Because MRI does not appear to cause harm or increase charges substantially, and is reassuring to patients, it is difficult to approve for or against it, calm though it does not improve patients' symptoms and functional outcomes

Jarvik JG et al. Rapid magnetic resonance imaging v radiographs for patients with cheap back pain. A randomized controll trial. JAMA June 4 2003;289:2810-8

COPYRIGHT 2004 American Academy of Family Physicians

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