Do I need a scan for my back pain?
There is a common belief in society that backs are easy to damage and hard to heal.
This often leads to a view that when a person develops back pain, a scan (x-ray, CT scan or MRI) is required to identify the cause of pain. However the latest research suggests that this is rarely true.
While scans are important to identify serious causes of back pain, such as cancer, infections and fractures, these only occur in a very small group of people (about 1%).
One of the problems with having your back scanned is they often identify things that sound scary but are actually normal and common in people without back pain.
For example, “disc degeneration” and “disc bulges” are very common in people without back pain, especially ageing people.
These changes don't predict the severity of a person’s back pain or level of activity limitation. However, being told you have “disc degeneration” or a “disc bulge” can lead people to believe their spine is damaged and needs protecting, resulting in a cascade of fear, muscle guarding and movement avoidance.
Most people will have an episode of back pain in their life – a bit like the flu. Like the flu, the symptoms can be severe and distressing, but for most people the pain resolves in a period of weeks. Triggers for an episode of back pain are things like inactivity or unaccustomed activity combined with being tired, stressed, sad and/or run down.
This can result in muscle tension and sensitivity of the spine’s structures. Understanding that having back pain (unless you have had a trauma) usually doesn't mean the spine is damaged, and that it’s safe to move, keep active, work and engage with valued activities is important to help with recovery.
If your back pain persists and is distressing, seek professional advise to rule out serious causes. If you do get a scan – remember that many of the things that show on a scan are normal and common in people without pain, so don't freak out.
The most effective things to manage back pain are the things you can do for yourself – good sleep, regular movement and physical activity, manage your stress and keep a positive mindset.
If you get stuck, find a health care practitioner who can coach you to get in control of your back and engage with healthy living. Don't get trapped into relying on someone to fix your spine – it rarely works in the long term.
Peter O’Sullivan is the John Curtin Distinguished Professor, Faculty of Health Sciences, Curtin University.
