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Study Questions Use of MRI Before Back-Pain Injections
Date:12/12/2011

By Kathleen Doheny
HealthDay Reporter

MONDAY, Dec. 12 (HealthDay News) -- Patients who need steroid injections to ease lower back pain frequently undergo an MRI beforehand. But a new study finds that the expensive imaging tests have little or no clinical value for these patients.

Researchers at Johns Hopkins University School of Medicine found that the MRI does not typically improve results for patients who are candidates for the injection, and it has only a minor effect on doctors' decision-making.

"More is not necessarily better," said study researcher Dr. Steven P. Cohen, an associate professor of anesthesiology and critical care medicine at Hopkins.

The study is published online Dec. 12 in the Archives of Internal Medicine.

Lower back pain is one of the top three reasons people seek medical attention in the United States, and epidural steroid injections are the most common treatment at U.S. pain clinics. The injections deliver cortisone directly into the spinal canal to ease inflammation and pain.

Indiscriminate use of MRIs, which cost about $1,500 each, prior to injection greatly adds to soaring health costs associated with back pain, the authors say.

The American College of Physicians recommends MRIs for injection candidates only when underlying conditions, such as fractures or tumors, are suspected. The American College of Occupational and Environmental Medicine recommends the imaging only when certain persistent neurologic symptoms fail to improve, according to background information in the study.

Trying to assess the value of pre-injection MRI, Cohen evaluated 132 patients -- average age 52 -- treated at one of several pain clinics in the United States for sciatica. This is a painful condition in which the root of the sciatic nerve at the bottom of the spinal column is compressed or pinched.

Patients were assigned to two groups. Both groups got MRIs. In one g
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