MRI Unnecessary Before Prescribing Steroid for Back Pain Patients, Researchers Say

Treating spine problems is one of the largest contributors to the rising costs of health care, and diagnostic imaging is often cited as one of the key reasons why. For one of the most common treatments for back pain, an Epidural Steroid Injection, an MRI beforehand may be unnecessary, according to researchers in a study published on-line this week in the Archives of Internal Medicine.Researchers examined the cases of 132 patients with severe sciatic who were scheduled for an injection. For the purposes of the study, physicians did not review an MRI in half of the cases before making a treatment decision. In none of those cases was non-injection therapy recommended. After three months, virtually the same number of patients in both groups viewed the procedure as an “overall success.” The authors conclude that MRI neither affects outcomes or decision-making for steroid injections. The study’s findings are significant because current guidelines on whether MRI should be used before an ESI are unequivocal. “The American College of Physicians recommends MRI only in the presence of serious or progressive neurological deficits, when a serious underlying condition is suspected, or when considering surgery or epidural steroid injections (ESI). Guidelines endorsed by the American College of Occupational and Environmental Medicine recommend MRI only in the presence of focal neurologic symptoms that persist for at least 6 weeks and are not trending toward improvement,” according to the study.