Unnecessary radiology reports
As I was scrolling through the ‘Guide to assessing psychological yellow flags in acute low back pain’ I gazed across a section suggesting “investigations in the first 4-6 weeks do not provide clinical benefit unless there are Red Flags present. There are risks associated with unnecessary radiology (X-rays and CT scans).” Their explanation is that radiological investigations carry the risk of potential harm from radiation-related effects. Good point. But perhaps it’s also worth considering the psychological risks of perceived threat.
Inherently, a radiology report is likely to increase threat, especially without education. Consider how strong the perception of ‘Danger in Me (DIM)’ would be when a health professional sends you to a radiologist who uses his expensive, fancy machine to magically look inside you. For your efforts, you’re provided a complicated report with some pretty scary sounding words on it. Any fear you previously had now seems to be confirmed (or exacerbated) by reliable people, high-tech equipment and medical jargon. It’s not easy to dethreaten such a potent message of damage.
What is ‘normal’?
It’s worth considering what a ‘normal’, asymptomatic radiology report would look like. Brinjikji et al. (2015) have systematically reviewed spinal imaging reports for those not in pain, and the results are pretty interesting. If we deconstruct their findings it seems that if an asymptomatic 60 year old walked through the door with lumbar imaging their prevalence estimate of reporting ‘disc degeneration’ is 88%, ‘disc signal loss’ is 86%, ‘disc bulge’ is 69%, ‘disc protrusion’ is 38% and even ‘spondylolisthesis’ at 23%. Remember, this (hypothetical) person is pain-free.
Credible evidence of danger
If we consider that ‘any credible evidence of danger to body tissue can increase pain’ (Moseley & Butler 2015) then we must consider the risk of unnecessary radiology reports. Hopefully, when patients come to us with reports in hand, our educational skills can help to detangle perceived threat and provide accurate explanation of what it means for them. As Brinjikji et al. (2015) concludes – “Many imaging-based degenerative features are likely part of normal aging and unassociated with pain”.
– Hayley Leake
We’re hitting the road and taking our NOI courses right across this great southern land:
Noosa 17 – 19 June Explain Pain and Graded Motor Imagery (Both courses SOLD OUT)
Wagga Wagga 16-17 July Explain Pain
Perth 15 – 17 October Explain Pain and Graded Motor Imagery
EP3 events have sold out three years running in Australia, and we are super excited to be bringing this unique format to the United States in late 2016 with Lorimer Moseley, Mark Jensen, David Butler, and few NOI surprises.
EP3 EAST Philadelphia, December 2, 3, 4 2016
EP3 WEST Seattle, December 9, 10, 11 2016
To register your interest, contact NOI USA:
p (610) 664-4465