Scan reports commonly describe spinal features that sound abnormal and worrying – yet these concerns are often misplaced and may in fact be harmful. A group of researchers from South Australia found that offering information about how normal these “abnormal” findings actually are – might influence how people recover from an episode of back pain.
By Emma Karran
Experiencing minor back pain is so common that it may be best thought of as a normal part of adult life. What is not normal is back pain that causes ongoing distress and long-term disability. It is intriguing that as technologies for investigating back pain have advanced – and scans such as X-Ray, CT and MRI have become more readily available – we have also seen a rise in back-related disability.
When providing reports on these scans, radiologists must describe in some detail what they see on the images. They regularly report features such as disc “bulges” or “protrusions”, and “degenerative” or “arthritic” changes. Recent scientific discoveries tell us however, that these features are very commonly found on the scans of people without back pain. They should perhaps be re-considered as “wrinkles on the inside” or the “kisses of time” – normal changes associated with aging rather than with damage or disease.
Previous studies have shown that receiving scans can have negative impacts on the way a person thinks, behaves and recovers from an episode of back pain. But what if these people had a better understanding of what their scans actually showed? If they were able to grasp that the worrying ‘abnormal’ findings were not abnormal; that the link between those findings and pain was likely to be very small; and that their scans revealed almost nothing about their chances of recovery. Would they think differently? Move more? Return more quickly to usual activity?
In a study, recently published in the Scandinavian Journal of Pain, researchers investigated whether including extra detail in spinal imaging reports – information explaining normal, expected, age-related findings – could change adults’ thoughts about the condition of their back. The randomised, online, ‘virtual-patient’ experiment indeed found benefits. Participants receiving the extra information viewed the condition of their back more positively.
While it remains uncertain whether this simple strategy promotes an early return to activity in real patients who receive scans – it certainly appears to be a question worth exploring further.
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