Why an MRI May Not Reveal the True Source of Your Pain

Does an MRI always show the source of pain?
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Patients in pain present to the Center for Healing And Regenerative Medicine (CHARM) every day with a variety of painful complaints that are interfering with their quality of life, sports, and work activities. Many have back pain, shoulder pain, knee pain, and other concerns that have been troubling them for years, and many of our patients have seen several other practitioners before seeing us. Many present with a prior X-Ray, MRI or CT Scan and they are convinced that their pain is coming from the abnormal findings noted on the scan. How much should we trust an MRI Scan of the knee, shoulder, or back to tell us with certainty the source of the pain?

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Cervical MRI Scan

It turns out, unfortunately… not very much.

The scans and X-Rays can describe the patient’s anatomy with very good accuracy. These technologies have been developed over many years by many scientists and do what they do quite well. The technology behind X-Rays, MRI Scans and CT Scans is very accurate. There are bone spurs, tissue tears, places where the nerves are compressed, thinned cartilage, disk herniations, arthritic joints, and a variety of other potentially painful problems. The problem is that many of these findings may not have any relevance to the patient’s pain concern. Many patients with no pain or neurological deficits have similar findings.

How Do You Have Significant MRI Findings but No Pain Symptoms?

We all age, and aging involves various tissues degenerating year by year. We unfortunately, usually, are not as healthy when we are 80 as we were when we were 18. These degenerative changes are very well visualized on MRI /CT scans and X-Rays. Many findings on the scans reflect the aging process and the accumulation of many microscopic injuries, which over time become easy to capture on a scan or X-Ray.

Many studies have investigated how often patients with no painful symptoms have significant MRI Scan findings. For spinal disk concerns, a systematic review by Brinjikji, et al, published in the American Journal of Neuroradiology in April 2015, showed that low back disk bulges occur ion up to 80% of people with no symptoms, disk protrusions in up to 40%, and disk degeneration up to 96%! (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464797/)

Martin Englund, MD, and his group studied knee MRI Scans and published in the New England Journal of Medicine in September 2008 that over 60% of patients with no knee pain had meniscus tears. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026731/)

Rebekah Lawrence, PT, PhD found over 40% of patients had rotator cuff tears with no shoulder pain or symptoms in her review published in the Journal of Bone and Joint Surgery in 2019. Many other studies have shown similar findings. Many patients who have no symptoms have abnormal scan findings. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7026731/)

So does this mean that there’s no way to get out of pain with your low back, knee, or shoulder? Absolutely not. An in-depth clinical evaluation with a detailed history, physical examination, review of your response to prior treatments, and review of your past and possible future studies will usually help your CHARM physician and physical therapist help you reach your goals of improved function, reduced or resolved pain, and improved quality of life. https://charmaustin.com/where-is-your-pain/#neckpain Most importantly, it is important to be careful how much confidence is placed solely on the results of an MRI Scan, CT Scan, or X-Ray.

You should be particularly concerned about proceeding with surgery for your back pain, knee pain, or shoulder pain, based solely on the findings of your scans and X-Rays. Many patients have a combination of different issues, some of which may show up on a study, but some issues may not be visualized on these studies. Many conditions respond well to non-surgical treatment such as physical therapy, tissue mobilization and manipulation, traditional injections such as precisely-guided  steroid injection https://charmaustin.com/relieve-pain-and-repair-injury/trigger-point-injections/, and regenerative injection techniques https://charmaustin.com/relieve-pain-and-repair-injury/.

Many structures are often involved when you have a painful knee, shoulder, back or other region. Some of these show up on your MRI or CT Scan, but many do not. There are a number of dynamic changes that occur with movement that are missed by an MRI or CT Scan, which requires that you lie in a set position to get the scan done. This is often the reason that so many surgeries do not result in complete pain relief. There are often other sources of pain that do not show up on a scan when you are in a specific position.

Many of these painful, challenging problems are successfully treated when the entire structure is treated comprehensively with regenerative injection therapy. Stimulating repair of the injured tissue with growth factors from your own blood using Platelet-Rich Plasma, and combining that with your own Stem Cells from your own Bone Marrow when needed, will often solve the variety of problems shown, and not shown, on your MRI or CT Scan. At CHARM, we have many years of experience treating these complex problems that are not fully understood based solely on an MRI Scan, CT Scan, or X-Rays.

David K. Harris, MD

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