Top of the pageDecision Point

You may want to have a say in this decision, or you may simply want to follow your doctor’s recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Low Back Pain: Should I Have an MRI?

Get the facts

Your options

  • Have an MRI.
  • Don’t have an MRI.

Key points to remember

  • An
    MRI is not a standard test for finding the cause of
    low back pain. A physical exam that includes questions about your medical
    history is enough to diagnose and treat most cases.
  • Since most low
    back pain gets better on its own, it’s often best to wait and see if you get
    better with time.
  • An MRI is helpful if your doctor suspects that
    disease or nerve damage is causing your pain.
  • MRIs are expensive.
    Health insurance may cover only part of the cost.
  • An MRI may find
    other problems that have nothing to do with your low back pain. This can lead
    to more tests.
FAQs

What causes low back pain?

Strained muscles and
ligaments are the most common cause of low back pain and stiffness. This type
of low back trouble generally goes away after 4 to 6 weeks of nonsurgical
treatment. An MRI usually isn’t helpful in these cases.

Pressure
on a spinal nerve can cause
sciatica symptoms, which usually include a shooting
pain down the back or side of the leg. Your leg may also feel weak, tingly, or
numb. This pressure on the nerve can be caused by:

  • A bulging or ruptured disc in your spine.
    This is also called a
    herniated disc or protrusion. It usually gets better
    within a month or two.
  • Arthritis.
  • Spinal stenosis.

Other serious causes of back pain, such as infection, a
tumor, or cancer, are rare.

Very few cases of low back pain are caused by serious disease or nerve-related problems. Imaging,
including MRI, is helpful for diagnosing and planning treatment only for these types
of conditions.

What is an MRI?

An
MRI is a test that uses a magnetic field and pulses of
radio wave energy to make pictures of the spine. MRI stands for “magnetic resonance imaging.”

For this test, your body is placed inside a special machine that
contains a strong magnet.

In some cases, a
contrast material is used during the MRI scan. This
means that you have a chemical injected into your bloodstream, through an
IV. The chemical makes certain areas show up better on
the MRI pictures.

The MRI can find problems such as infection or a
tumor. It may also find things that aren’t normal but that aren’t causing any
problems.

MRI issues

An MRI isn’t painful, but there are certain details
about having an MRI that you should know about:

  • Loud noises. The
    machine makes loud tapping or snapping noises. Earplugs or headphones with
    music are usually offered to help block the noise.
  • Being confined. Some people feel nervous (claustrophobic)
    about being confined in that small space. If this worries you, you may be given
    medicine (a sedative) to help you relax. Some MRI machines, called “open MRI,”
    are now made so that the machine doesn’t enclose your entire body. Open MRI machines may be helpful if you are claustrophobic, but they aren’t available
    everywhere. The images from an
    open MRI may not be as good as those from a standard MRI machine.
  • Lying very still. You must lie very
    still for quite a while so that the machine can get clear pictures. For people
    with back pain, this can be hard. Talk to your doctor if you’re worried about
    having to lie on your back.
  • Time. An MRI
    usually takes 30 to 60 minutes but can take as long as 2
    hours.
  • Cost. MRIs are expensive. Costs range
    from several hundred to several thousand dollars. Health insurance may cover
    only part of the cost.
  • False-positive results. A
    false-positive test result is one that appears to find a problem when in fact
    there isn’t one. This can lead to more tests that really aren’t needed. And it
    may cause needless worry that something is wrong.

When is an MRI scan helpful?

An MRI is not a
standard test for finding the cause of low back pain. A complete exam that
includes questions about your medical history is enough to diagnose and treat
most low back pain.

An MRI is best used when your doctor suspects
a specific problem-something other than the muscle strain that causes most low
back pain.

An MRI usually isn’t done when simple muscle strain is
suspected, because:

  • An MRI will not show muscle strains or other problems with soft tissues.
  • The pain usually will go away on its own,
    although it may take several months.
  • An MRI won’t change your
    treatment plan.
  • An MRI is expensive.

What are the risks of MRI?

An MRI can be loud, but
the test itself isn’t painful.

There are no known harmful effects
from the magnet used in MRI machines, but it is very strong:

  • It can affect pacemakers, artificial limbs,
    and other medical devices that contain iron.
  • Any loose metal
    object in the body-for example, a surgical clip or a bullet fragment-could
    cause damage or injury if it gets pulled toward the strong magnet.
  • Metal parts in the eyes can damage the
    retina. If you may have metal fragments in your eye,
    you may need an X-ray of your eyes before you can have an MRI. If metal is
    found, then you won’t be able to have the MRI.
  • Iron pigments in
    tattoos or tattooed eyeliner can cause skin or eye irritation.

There
is a slight risk of an allergic reaction if
contrast material is used during the MRI. But most
reactions are mild and can be treated with medicine. There also is a slight
risk of an infection at the
IV site.

If you are pregnant, be sure to tell your doctor. The contrast material that contains gadolinium could be harmful to your baby.

Some contrast materials can
cause a serious skin problem (called nephrogenic fibrosing dermopathy) in
people who have
kidney failure. Before you have an MRI scan, tell your
doctor if you have any kidney disease.

Why might your doctor recommend an MRI?

Your
doctor might recommend an MRI if he or she suspects that your low back pain is
caused by something more serious than muscle strain. This may be the case
if:

  • Your history and physical
    exam show signs of a serious problem, such as a fracture,
    tumors, infection, or nerve damage.
  • You are older than 70. Your doctor may also recommend testing if you are older than 50 and also have osteoporosis or a history of compression fracture.
  • You have had osteoporosis for a long time or you have diabetes.
  • Your body’s defense system (immune system) is not able to fight infection.
  • You have a
    history of long-term steroid use or a history of drug abuse.
  • You have a
    history of a previous spine injury or back surgery.
  • You have symptoms related to compression on a certain nerve root or roots.
  • Back
    pain has not improved after at least 6 weeks of home treatment that may include
    pain relievers, heat or ice, and exercises.

Compare your options

Compare

What is usually involved?

What are the benefits?

What are the risks and side effects?

Have an MRI
Have an MRI

  • You lie on a table that slides into
    the MRI scanner.
  • You may wear a cloth harness that can be pulled
    during the test to see how your spine moves.
  • Your head, chest, and
    arms may be held with straps to help you stay very still.
  • The MRI may not bother you at all. Some people even fall
    asleep.
  • If being enclosed in the machine makes you very nervous,
    you may get medicine to help you relax.
  • An MRI can find serious problems
    that may be causing your low back pain.
  • There are no known
    harmful effects from an MRI. But the magnet is very strong and can cause a problem
    if there are any loose metal objects in or around your body.
  • There
    is a slight risk of an allergic reaction to
    contrast material that may be used during an MRI. Some
    contrast material can cause a serious skin problem in people with
    kidney failure.
  • An MRI may find other
    problems that have nothing to do with your low back pain. This can lead to more
    tests or treatment.
Don’t have an MRI

Don’t have an MRI

  • Your doctor will plan your
    treatment after doing a physical exam and asking you questions about your
    medical history.
  • A physical exam that includes
    questions about your medical history is all that is needed to diagnose most
    cases of low back pain.
  • An MRI can be done later if treatment is
    not working.
  • If a serious
    problem is causing your low back pain and is not diagnosed, it may not get
    treated. Without the right treatment, you could have more pain and other health
    problems in the future.

Personal stories about deciding whether to have an MRI for low back pain

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I injured
my back about a month ago lifting my daughter out of her car seat. I’ve been
doing all the home treatment that my doctor recommended: ice, walking,
anti-inflammatories, and rest from activities that bother it. I went to a
physical therapy class that taught me how to lift properly and protect my back.
My leg pain and other symptoms are a little better every week, but they are
definitely still there. My doctor says that based on my symptoms, she doesn’t
think there is anything really serious going on but that it would be reasonable
to have an MRI scan now if I am willing to have surgery. Even though I’m tired
of the pain, it is getting better (slowly), and I think I will just hold off
for a few more weeks.

Greg, age 38

My back and leg pain has been constant and
severe since I twisted my back about 3 months ago. Most of the pain is in my
leg, which makes my doctor and me think that I have a pinched nerve. I also
have severe weakness in my leg. I’m usually the type of person who tries to
wait things out, but this is disabling. I’m going to have the MRI, and if it
shows a problem that can be fixed, I’ll talk to my doctor about what I can do
next.

Michelle, age
35

If I was in my 30s again and still working
as a roofer, I would be having an MRI and surgery as soon as I could to treat
my herniated disc. But my work now doesn’t depend as much on my ability to lift
and carry heavy loads, so I can wait for my symptoms to go away on their own.
I’m going to try exercise and anti-inflammatories to see if I can speed up the
process and relieve the pain without surgery.

Bob, age 55

I injured
my back about 6 weeks ago. I was ready to have surgery right then, but my
doctor encouraged me to wait awhile. The pain is still as bad as it ever was,
and now it is more in my leg than in my back. I want surgery more than ever.
I’m going to have an MRI, and then my doctor and I can see if it shows anything
that can be helped with surgery.

Franco, age 54

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have an MRI

Reasons not to have an MRI

I’ve had low back pain for several months, and I want to find out if something serious is wrong.

I’m willing to give my low back pain more time to go away on its own, even if it takes a year.

More important
Equally important
More important

If the MRI shows a problem that can be fixed with surgery, I’m ready to have surgery.

Even if an MRI showed a problem that surgery could fix, I wouldn’t want to have surgery.

More important
Equally important
More important

I’m not worried about the cost of an MRI.

I don’t want to pay lots of money for a test that might not help me.

More important
Equally important
More important

I’m not worried that an MRI could lead to more testing or treatment that might not help me.

I worry that the results could lead to more testing or treatment that might not help me.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you’ve thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having an MRI

NOT having an MRI

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1, Do most doctors order an MRI in cases of low back pain?
2, Should you ask your doctor for an MRI when you first get low back pain?
3, Is an MRI ever helpful in cases of low back pain?

Decide what’s next

1,Do you understand the options available to you?
2,Are you clear about which benefits and side effects matter most to you?
3,Do you have enough support and advice from others to make a choice?

Certainty

1.
How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

Your Summary

Here’s a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision 

Next steps

Which way you’re leaning

How sure you are

Your comments

Your knowledge of the facts 

Key concepts that you understood

Key concepts that may need review

Getting ready to act 

Patient choices

Credits and References

Credits
Author Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP – Emergency Medicine
Primary Medical Reviewer Adam Husney, MD – Family Medicine
Primary Medical Reviewer Kathleen Romito, MD – Family Medicine
Specialist Medical Reviewer Jeffrey N. Katz, MD, MPH – Rheumatology

References
Other Works Consulted
  • American College of Radiology (2011). ACR Appropriateness Criteria: Low Back Pain. Available online: http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonNeurologicImaging/LowBackPainDoc7.aspx.
  • Chou R, et al. (2011). Diagnostic imaging for low back pain: Advice for high-value health care from the American College of Physicians. Annals of Internal Medicine, 154(3): 181-189.
You may want to have a say in this decision, or you may simply want to follow your doctor’s recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Low Back Pain: Should I Have an MRI?

Here’s a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • Have an MRI.
  • Don’t have an MRI.

Key points to remember

  • An
    MRI is not a standard test for finding the cause of
    low back pain. A physical exam that includes questions about your medical
    history is enough to diagnose and treat most cases.
  • Since most low
    back pain gets better on its own, it’s often best to wait and see if you get
    better with time.
  • An MRI is helpful if your doctor suspects that
    disease or nerve damage is causing your pain.
  • MRIs are expensive.
    Health insurance may cover only part of the cost.
  • An MRI may find
    other problems that have nothing to do with your low back pain. This can lead
    to more tests.
FAQs

What causes low back pain?

Strained muscles and
ligaments are the most common cause of low back pain and stiffness. This type
of low back trouble generally goes away after 4 to 6 weeks of nonsurgical
treatment. An MRI usually isn’t helpful in these cases.

Pressure
on a spinal nerve can cause
sciatica symptoms, which usually include a shooting
pain down the back or side of the leg. Your leg may also feel weak, tingly, or
numb. This pressure on the nerve can be caused by:

  • A bulging or ruptured disc in your spine.
    This is also called a
    herniated disc or protrusion. It usually gets better
    within a month or two.
  • Arthritis.
  • Spinal stenosis.

Other serious causes of back pain, such as infection, a
tumor, or cancer, are rare.

Very few cases of low back pain are caused by serious disease or nerve-related problems. Imaging,
including MRI, is helpful for diagnosing and planning treatment only for these types
of conditions.

What is an MRI?

An
MRI is a test that uses a magnetic field and pulses of
radio wave energy to make pictures of the spine . MRI stands for “magnetic resonance imaging.”

For this test, your body is placed inside a special machine that
contains a strong magnet.

In some cases, a
contrast material is used during the MRI scan. This
means that you have a chemical injected into your bloodstream, through an
IV. The chemical makes certain areas show up better on
the MRI pictures.

The MRI can find problems such as infection or a
tumor. It may also find things that aren’t normal but that aren’t causing any
problems.

MRI issues

An MRI isn’t painful, but there are certain details
about having an MRI that you should know about:

  • Loud noises. The
    machine makes loud tapping or snapping noises. Earplugs or headphones with
    music are usually offered to help block the noise.
  • Being confined. Some people feel nervous (claustrophobic)
    about being confined in that small space. If this worries you, you may be given
    medicine (a sedative) to help you relax. Some MRI machines, called “open MRI,”
    are now made so that the machine doesn’t enclose your entire body. Open MRI machines may be helpful if you are claustrophobic, but they aren’t available
    everywhere. The images from an
    open MRI may not be as good as those from a standard MRI machine .
  • Lying very still. You must lie very
    still for quite a while so that the machine can get clear pictures. For people
    with back pain, this can be hard. Talk to your doctor if you’re worried about
    having to lie on your back.
  • Time. An MRI
    usually takes 30 to 60 minutes but can take as long as 2
    hours.
  • Cost. MRIs are expensive. Costs range
    from several hundred to several thousand dollars. Health insurance may cover
    only part of the cost.
  • False-positive results. A
    false-positive test result is one that appears to find a problem when in fact
    there isn’t one. This can lead to more tests that really aren’t needed. And it
    may cause needless worry that something is wrong.

When is an MRI scan helpful?

An MRI is not a
standard test for finding the cause of low back pain. A complete exam that
includes questions about your medical history is enough to diagnose and treat
most low back pain.

An MRI is best used when your doctor suspects
a specific problem-something other than the muscle strain that causes most low
back pain.

An MRI usually isn’t done when simple muscle strain is
suspected, because:

  • An MRI will not show muscle strains or other problems with soft tissues.
  • The pain usually will go away on its own,
    although it may take several months.
  • An MRI won’t change your
    treatment plan.
  • An MRI is expensive.

What are the risks of MRI?

An MRI can be loud, but
the test itself isn’t painful.

There are no known harmful effects
from the magnet used in MRI machines, but it is very strong:

  • It can affect pacemakers, artificial limbs,
    and other medical devices that contain iron.
  • Any loose metal
    object in the body-for example, a surgical clip or a bullet fragment-could
    cause damage or injury if it gets pulled toward the strong magnet.
  • Metal parts in the eyes can damage the
    retina. If you may have metal fragments in your eye,
    you may need an X-ray of your eyes before you can have an MRI. If metal is
    found, then you won’t be able to have the MRI.
  • Iron pigments in
    tattoos or tattooed eyeliner can cause skin or eye irritation.

There
is a slight risk of an allergic reaction if
contrast material is used during the MRI. But most
reactions are mild and can be treated with medicine. There also is a slight
risk of an infection at the
IV site.

If you are pregnant, be sure to tell your doctor. The contrast material that contains gadolinium could be harmful to your baby.

Some contrast materials can
cause a serious skin problem (called nephrogenic fibrosing dermopathy) in
people who have
kidney failure. Before you have an MRI scan, tell your
doctor if you have any kidney disease.

Why might your doctor recommend an MRI?

Your
doctor might recommend an MRI if he or she suspects that your low back pain is
caused by something more serious than muscle strain. This may be the case
if:

  • Your history and physical
    exam show signs of a serious problem, such as a fracture,
    tumors, infection, or nerve damage.
  • You are older than 70. Your doctor may also recommend testing if you are older than 50 and also have osteoporosis or a history of compression fracture.
  • You have had osteoporosis for a long time or you have diabetes.
  • Your body’s defense system (immune system) is not able to fight infection.
  • You have a
    history of long-term steroid use or a history of drug abuse.
  • You have a
    history of a previous spine injury or back surgery.
  • You have symptoms related to compression on a certain nerve root or roots.
  • Back
    pain has not improved after at least 6 weeks of home treatment that may include
    pain relievers, heat or ice, and exercises.

2. Compare your options

  Have an MRI Don’t have an MRI
What is usually involved?
  • You lie on a table that slides into
    the MRI scanner.
  • You may wear a cloth harness that can be pulled
    during the test to see how your spine moves.
  • Your head, chest, and
    arms may be held with straps to help you stay very still.
  • The MRI may not bother you at all. Some people even fall
    asleep.
  • If being enclosed in the machine makes you very nervous,
    you may get medicine to help you relax.
  • Your doctor will plan your
    treatment after doing a physical exam and asking you questions about your
    medical history.
What are the benefits?
  • An MRI can find serious problems
    that may be causing your low back pain.
  • A physical exam that includes
    questions about your medical history is all that is needed to diagnose most
    cases of low back pain.
  • An MRI can be done later if treatment is
    not working.
What are the risks and side effects?
  • There are no known
    harmful effects from an MRI. But the magnet is very strong and can cause a problem
    if there are any loose metal objects in or around your body.
  • There
    is a slight risk of an allergic reaction to
    contrast material that may be used during an MRI. Some
    contrast material can cause a serious skin problem in people with
    kidney failure.
  • An MRI may find other
    problems that have nothing to do with your low back pain. This can lead to more
    tests or treatment.
  • If a serious
    problem is causing your low back pain and is not diagnosed, it may not get
    treated. Without the right treatment, you could have more pain and other health
    problems in the future.

Personal stories

Personal stories about deciding whether to have an MRI for low back pain

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

“I injured my back about a month ago lifting my daughter out of her car seat. I’ve been doing all the home treatment that my doctor recommended: ice, walking, anti-inflammatories, and rest from activities that bother it. I went to a physical therapy class that taught me how to lift properly and protect my back. My leg pain and other symptoms are a little better every week, but they are definitely still there. My doctor says that based on my symptoms, she doesn’t think there is anything really serious going on but that it would be reasonable to have an MRI scan now if I am willing to have surgery. Even though I’m tired of the pain, it is getting better (slowly), and I think I will just hold off for a few more weeks.”

— Greg, age 38

“My back and leg pain has been constant and severe since I twisted my back about 3 months ago. Most of the pain is in my leg, which makes my doctor and me think that I have a pinched nerve. I also have severe weakness in my leg. I’m usually the type of person who tries to wait things out, but this is disabling. I’m going to have the MRI, and if it shows a problem that can be fixed, I’ll talk to my doctor about what I can do next.”

— Michelle, age
35

“If I was in my 30s again and still working as a roofer, I would be having an MRI and surgery as soon as I could to treat my herniated disc. But my work now doesn’t depend as much on my ability to lift and carry heavy loads, so I can wait for my symptoms to go away on their own. I’m going to try exercise and anti-inflammatories to see if I can speed up the process and relieve the pain without surgery.”

— Bob, age 55

“I injured my back about 6 weeks ago. I was ready to have surgery right then, but my doctor encouraged me to wait awhile. The pain is still as bad as it ever was, and now it is more in my leg than in my back. I want surgery more than ever. I’m going to have an MRI, and then my doctor and I can see if it shows anything that can be helped with surgery.”

— Franco, age 54

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have an MRI

Reasons not to have an MRI

I’ve had low back pain for several months, and I want to find out if something serious is wrong.

I’m willing to give my low back pain more time to go away on its own, even if it takes a year.

             
More important
Equally important
More important

If the MRI shows a problem that can be fixed with surgery, I’m ready to have surgery.

Even if an MRI showed a problem that surgery could fix, I wouldn’t want to have surgery.

             
More important
Equally important
More important

I’m not worried about the cost of an MRI.

I don’t want to pay lots of money for a test that might not help me.

             
More important
Equally important
More important

I’m not worried that an MRI could lead to more testing or treatment that might not help me.

I worry that the results could lead to more testing or treatment that might not help me.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. Where are you leaning now?

Now that you’ve thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having an MRI

NOT having an MRI

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
Do most doctors order an MRI in cases of low back pain?

  • Yes

  • No
  • I’m not sure

You’re right. An MRI is not a standard test for finding the cause of low back pain. It’s only helpful in certain cases.

2.
Should you ask your doctor for an MRI when you first get low back pain?

  • Yes

  • No
  • I’m not sure

That’s correct. Since most low back pain gets better on its own, it’s often best to wait and see if you get better with time.

3.
Is an MRI ever helpful in cases of low back pain?

  • Yes
  • No

  • I’m not sure

That’s right. An MRI is helpful if your doctor suspects that disease or nerve damage is causing your pain.

Decide what’s next

1.
Do you understand the options available to you?

2.
Are you clear about which benefits and side effects matter most to you?

3.
Do you have enough support and advice from others to make a choice?

Certainty

1.
How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2.
Check what you need to do before you make this decision.

  • I’m ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

 
Credits
By Healthwise Staff
Primary Medical Reviewer William H. Blahd, Jr., MD, FACEP – Emergency Medicine
Primary Medical Reviewer Adam Husney, MD – Family Medicine
Primary Medical Reviewer Kathleen Romito, MD – Family Medicine
Specialist Medical Reviewer Jeffrey N. Katz, MD, MPH – Rheumatology

References
Other Works Consulted
  • American College of Radiology (2011). ACR Appropriateness Criteria: Low Back Pain. Available online: http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonNeurologicImaging/LowBackPainDoc7.aspx.
  • Chou R, et al. (2011). Diagnostic imaging for low back pain: Advice for high-value health care from the American College of Physicians. Annals of Internal Medicine, 154(3): 181-189.

Note: The “printer friendly” document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.