Back pain is a common condition that affects most people at some point in their lives. While many episodes of back pain resolve with rest, over-the-counter medications, and physical therapy, sometimes imaging tests like an MRI (magnetic resonance imaging) scan are needed to help determine the cause of the pain.
When should you get an MRI for back pain?
An MRI may be recommended if:
- Your back pain does not improve with standard treatments like rest and pain medications after 6 weeks
- You have signs of nerve damage like numbness, tingling, or weakness in your legs
- You have a history of cancer
- You have risk factors for a spinal infection
- You have symptoms suggesting a serious underlying condition like cauda equina syndrome
MRIs can provide detailed images of the spine and surrounding structures to help identify potential sources of back pain like bulging or herniated discs, spinal stenosis (narrowing of the spinal canal), tumors, infections, fractures, or nerve damage.
When can your doctor decide to skip the MRI?
An MRI may not be necessary if:
- Your back pain has only lasted a few weeks
- Your symptoms are improving with conservative treatment
- You do not have any neurological symptoms like weakness/numbness
- You do not have any underlying medical conditions that increase your risk
For acute back pain without neurological symptoms that has lasted less than 6 weeks, guidelines generally recommend trying other conservative therapies first before considering advanced imaging like an MRI. MRIs in the first 6 weeks of back pain have not been found to improve outcomes.
Pros and cons of getting an MRI for back pain
Some pros of getting an MRI for back pain include:
- Can detect problems that may be missed on regular x-rays like disc, nerve, or spinal cord issues
- Does not use ionizing radiation like CT scans
- Provides high-resolution, detailed images of soft tissues around the spine
- May identify sources of pain that can guide appropriate treatment
Some cons of getting an MRI for back pain:
- High cost compared to other imaging modalities like x-rays or CT scans
- Limited availability and scheduling delays
- May detect incidental findings unrelated to pain that can lead to additional, unnecessary tests
- Motion artifact can interfere with image quality
- Cannot be done if patient has metal implants or claustrophobia
What does the research say about MRIs for back pain?
Several research studies have looked at the role of MRIs in the treatment of back pain:
- A randomized trial in the New England Journal of Medicine found that routine early MRI scans for acute back pain did not improve clinical outcomes compared to usual care without early MRI.
- Clinical guidelines from the American College of Physicians recommend against MRI imaging within the first 6 weeks of back pain in patients with no signs of serious underlying conditions.
- A study in JAMA Internal Medicine found a 3-fold increase in lumbar spine MRIs from 1994 to 2015 with no improvement in patient outcomes.
- A randomized trial published in Lancet found that immediate MRI scans for low back pain did not reduce subsequent healthcare costs compared to delayed MRI scans.
Based on this research, routine early MRI imaging for acute or subacute back pain in patients without any neurological symptoms is generally not recommended. However, MRIs can still provide value in certain clinical scenarios when serious underlying causes need to be ruled out.
Who should not get an MRI for back pain?
The following groups of patients may wish to avoid MRIs for back pain:
- Pregnant women: Although generally safe during pregnancy, MRIs expose the fetus to strong magnetic fields so ultrasound is preferred when possible.
- Patients with metallic implants or pacemakers: The magnets in an MRI can interact with metal devices and displace them, so MRIs are contraindicated in some cases.
- Claustrophobic patients: Some people experience anxiety or panic attacks in the confining MRI scanner.
- Patients with kidney disease: Certain contrast dyes used in some MRIs can worsen kidney function.
Patients should let their doctor know if they have any implants, devices, claustrophobia, or kidney issues before undergoing an MRI scan.
How should you prepare for an MRI for back pain?
To prepare for a lumbar spine MRI for back pain, patients should:
- Inform their doctor of any medical implants, devices, or metal fragments in their body
- Stop taking any blood thinners for a specified number of days if prescribed by their doctor
- Wear comfortable, loose-fitting clothing without metal snaps, zippers, buttons, or underwire
- Leave all jewelry and valuables at home
- Arrange for a driver to take them home afterwards if receiving sedation
- Try relaxation techniques if prone to claustrophobia or anxiety about the scan
- Plan to lie still for 30-60 minutes during the actual MRI
Proper preparation can help ensure the MRI goes smoothly and yields high-quality images to assist with a back pain diagnosis.
What happens during an MRI for back pain?
Here is a general overview of what to expect during an MRI scan for back pain:
- You will be asked to change into a hospital gown to remove any metal objects
- An IV may be placed if you are receiving contrast dye or sedation medication
- You will lie face up on a movable scan table that slides into a tunnel-like scanner
- A device called a coil will be positioned over your lumbar spine to enhance image quality
- You will hear loud tapping or knocking noises during the scan as the MRI machine switches on and off
- You will need to lie very still but can communicate at any time via an intercom system
- A typical lumbar spine MRI takes 30-60 minutes
The technologist will be monitoring you from a nearby room and can communicate via intercom if needed. Some facilities allow you to listen to music during the MRI to help relaxation. Let your doctor know if you have any concerns about claustrophobia or anxiety prior to the test.
How do you get the results of an MRI for back pain?
After the MRI, a radiologist will review the images and send a report to your ordering physician. This detailed report will describe any abnormal findings as well as the radiologist’s interpretation.
Your own doctor will then discuss the results with you – typically at a follow-up appointment scheduled days to weeks after the MRI. Rather than reading the report yourself, it is best to review the MRI results with your doctor, who can explain the findings in relation to your symptoms and treatment options.
Key things to discuss with your doctor include:
- What conditions, if any, were identified by the MRI?
- Do the MRI findings explain my symptoms?
- What treatment options do I have based on these results?
- Do I need to follow up with a specialist like a neurosurgeon or orthopedist?
Understanding the results of your lumbar spine MRI scan can provide valuable insight into the cause of your back pain and help guide appropriate treatment steps.
How much does an MRI for back pain cost?
According to Fair Health, the national average charge for a lumbar spine MRI without contrast is:
- $1,009 for uninsured patients
- $496 for patients with commercial insurance like a PPO or HMO
- $483 for Medicare patients
With contrast dye, average MRI charges increase to $1,195 for uninsured patients, $597 for commercial insurance, and $582 for Medicare.
Many factors affect MRI costs including:
- Your location and the imaging facility
- With or without contrast dye
- Your insurance plan’s negotiated rate
- Your annual deductible amount
Speak to your insurance provider and imaging facility to get an accurate estimate of your out-of-pocket MRI costs. Financial assistance like payment plans or discounted rates may be available for qualifying patients.
Frequently asked questions
How do I know if I should get an MRI for my back pain?
Discuss your back pain symptoms and history with your doctor. They may recommend an MRI if your pain is severe or unrelieved after several weeks, you have neurological symptoms like weakness/numbness, or serious underlying causes need to be evaluated. MRIs are usually unnecessary for acute back pain without complications.
What are the risks of getting an MRI?
MRIs use only magnetic fields and radio waves with no radiation exposure. Risks are minimal but can include reactions to contrast dye, implants getting dislodged by the magnets, or emergence of anxiety/claustrophobia during the scan. Let your provider know if you have any implants, devices, kidney issues or claustrophobia.
How accurate is an MRI for diagnosing back pain?
Lumbar spine MRI has excellent sensitivity and specificity for evaluating soft tissues around the spinal cord and nerve roots. However, some findings like disc bulges and degeneration are very common even in people without back pain. Correlating MRI results with your symptoms is key for an accurate diagnosis.
Can I get an MRI if I am pregnant?
MRIs are typically avoided in the first trimester of pregnancy unless strongly clinically indicated. After the first trimester, MRIs appear to be low risk but the effects remain uncertain. Your provider will weigh the benefits against potential risks. Ultrasound often provides sufficient imaging without MRI exposure during pregnancy.
How should I prepare for my lumbar spine MRI?
Avoid wearing any metal on your body, inform staff of any implants/devices, follow scanner clothing guidelines, arrange transportation after sedation, and consider relaxation techniques if you have claustrophobia/anxiety. Your doctor may recommend stopping blood thinners prior to the scan depending on your medical history.
The bottom line
MRIs can play an important role in diagnosing back pain when serious causes need to be evaluated. However, research shows that routine early MRI scans often do not improve outcomes for typical acute back pain. Discuss your specific symptoms and risks with your doctor to determine if obtaining an MRI is appropriate for your situation.