December 12, 2018
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Do you really need that MRI of your back?

Contributed photo | BDN
Contributed photo | BDN
Dr. Michael Noonan

I’ve seen a lot of patients waste time and money when trying to get relief for their pain. A good example is “Ralph”, a 56-year-old man with intense low back and leg pain that had been bothering him for two months. Despite having spent a lot of money on medicine, shots and testing — the MRI alone was over $1,000 — there was no relief in sight. The pain prevented him from working, sleeping or really doing much of anything at all. He came to my office desperately seeking some relief.

I took a quick look at the MRI and X-ray reports, but they didn’t interest me much. Like almost all people his age, there was some arthritis, and some disc wearing and bulging. But these were not the cause of his pain; I am sure the MRI would’ve looked the same a month before his back and leg pain started.

As a doctor of chiropractic, I was trained to rely far more on the patient’s history — what caused it, how long it has been there, previous episodes, the timing and nature of the pain, etc. — and the exam. Of course, I had a strong suspicion of what was causing his pain — joint and muscle problems in the low back and hip — and the exam showed exactly that. If he had a badly pinched nerve that might need surgery, I’d find that from the exam, not the MRI.

He responded quickly to care — there was some relief after the first visit, and by the fourth visit, he felt 75 percent better. Currently, he has very little low back or leg pain, and he is back to doing heavy work at times. There is still some numbness in the foot, which will probably either be permanent or slowly ease over time. He continues to come for treatment once a month to control his problem; he doesn’t want a repeat of what happened to him.

I’m confident that if a follow-up MRI were done today, it would look no different than it did when he was in so much pain.

Of course, MRIs can be very helpful; they are great for looking for diseases, such as cancer. But they simply don’t show the cause of the pain for most back and neck pain patients. Also they don’t show whether a patient will benefit from chiropractic care, acupuncture or any other wellness-based care. And perhaps most importantly, they send the doctors in the wrong direction, treating all the incidental findings (arthritis, disc bulging) while the real problem goes untreated.

As another example: I’m treating a woman who started care because of disabling hip and knee pain. The X-rays showed advanced arthritis, enough that the doctor recommended a hip replacement. (The drugs and shots they used weren’t very helpful, other than some temporary relief.) She was reluctant to have surgery, so she started care at our office.

We started with gentle manipulation, modified because of the arthritis. We then went to acupuncture. She’s done very well with this program — she is pain-free most of the time, and is very active, looking forward to starting her garden again this spring. She still comes to the office every six weeks to keep things in check.

Just like with the first patient, if we were to X-ray her hip today, it would look no better; perhaps her arthritis has even progressed slightly. But her pain level is zero most of the time, and her activity level is much better as well. It turns out the information gained by taking X-rays was not helpful for her, and in fact only caused the doctors to focus on the results of the test, rather than on what would be the most effective treatment.

Of course, not every patient does this well; there are some that I have recommended go to surgery because they had an urgent problem, or our treatment was not working. But most do very well with care, especially if no time was lost running expensive tests, trying different drugs and shots, etc.

On another note, this will be the last column I write for the Bangor Daily News. I’ll be starting as the president of the Maine Chiropractic Association next month, which will demand a lot of my time. I thank the BDN for the opportunity to express an alternate health care point of view from our current drug-based system. I have enjoyed writing these columns immensely, and have learned a lot from them.

Dr. Michael Noonan practices chiropractic, chiropractic acupuncture and other wellness therapies in Old Town. He can be reached at noonanchiropractic@gmail.com.

 


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