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To Image or Not to Image...

Musculoskeletal pain is a common complaint among patients, and both healthcare professionals and patients often rush to imaging to diagnose the cause of pain. However, over-reliance on imaging can be problematic, as it may lead to unnecessary medical interventions and increased healthcare costs. A good exam and history can often eliminate the need for imaging in most cases, as many musculoskeletal conditions can be diagnosed based on clinical presentation alone.


One of the main reasons why imaging is overused is the belief that the amount of pain correlates with the amount of damage, or damage at all. However, this is not rarely the case, as many people experience pain without any underlying structural damage. In fact, studies have shown that the presence of imaging abnormalities, such as disc herniation or degeneration, is common in people without any symptoms of pain (Brinjikji et al., 2015).

Furthermore, the findings on imaging may not necessarily correlate with the patient's symptoms. For instance, a patient may experience severe pain but have a normal imaging result, or vice versa. This is because pain is a subjective experience that is influenced by various factors, such as emotional state, stress, and past experiences (Chou et al., 2011).

Another potential harm of overusing imaging is that it can make the patient feel fragile and dependent on medical interventions. This can lead to unnecessary treatments, such as surgery or injections, which may not be effective in relieving pain (Lin et al., 2019).

Research has shown that most musculoskeletal conditions, such as back pain, neck pain, and knee pain, resolve within six weeks with conservative management, such as physical therapy and strengthening exercises (Foster et al., 2018). In fact, a systematic review by Foster et al. (2018) found that physical therapy was more effective than imaging or surgery in managing back pain.

While overuse of imaging in musculoskeletal cases can lead to unnecessary interventions, it is important to recognize that imaging is still a valuable tool in certain situations. For instance, imaging may be necessary when there is suspicion of a fracture, dislocation, or infection. Imaging can also be helpful in cases where there is persistent pain or neurologic deficits that do not respond to conservative management, such as physical therapy. Additionally, imaging may be useful in planning for surgical interventions, such as joint replacement or spinal fusion. In general, imaging should be used judiciously, with consideration given to the risks and benefits of the procedure, and in consultation with a healthcare provider.

Imaging can be a useful tool in diagnosing musculoskeletal conditions, it should not be overused. A good exam and history can often provide enough information to diagnose the cause of pain, and imaging should only be used when necessary.


References:

Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., ... & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811-816.

Chou, R., Qaseem, A., Snow, V., Casey, D., Cross Jr, J. T., Shekelle, P., ... & Owens, D. K. (2011). Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine, 147(7), 478-491.

Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., ... & Turner, J. A. (2018). Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet, 391(10137), 2368-2383.

Lin, I., Wiles, L., Waller, R., Goucke, R., Nagree, Y., Gibberd, M., ... & O'Sullivan, P. (2019). What does best practice care for musculos


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