The Hidden Dangers of Early MRI for Low Back Pain: Why More Imaging Isn’t Always Better

Introduction

When back pain strikes, it’s natural to want answers fast. Many people—both patients and healthcare providers—believe that getting an MRI early will speed up diagnosis and lead to better treatment. After all, if we can see the problem, we can fix it, right?

But what if I told you that early MRIs for low back pain can actually make things worse?

A pivotal 2013 study by Webster et al. revealed that getting an MRI within the first 30 days of low back pain leads to higher medical costs, prolonged disability, and worse outcomes—even when leg symptoms are present. In other words, the scan itself could be contributing to persistent pain and unnecessary treatments.

So why is this happening? Let’s dive into the science behind why more imaging isn’t always better .

The Research: How Early MRI Impacts Recovery & Costs

Webster et al. (2013) examined how early MRI affects patients with both low back pain and low back pain with referred leg symptoms. Their findings were striking:

📌 Patients who received an early MRI had significantly higher medical costs:

• $12,948–$13,816 higher costs per case for people with low back pain alone and people with low back pain with referred leg symptoms.

📌 Early MRI was linked to a significantly lower likelihood of returning to work:

• 72% lower return-to-work rates for radiculopathy cases.

• 68% lower return-to-work rates for non-specific low back pain.

In short, early imaging did not improve recovery—it actually worsened it by increasing medicalisation and disability rates.

But why? Let’s look at the psychological and clinical consequences of unnecessary imaging.

Why Early MRI Can Make Pain Worse

1. It Finds “Problems” That Aren’t Really Problems

One of the biggest issues with MRI scans is that they can detect structural changes in the spine that may have nothing to do with pain.

• 37% of 20-year-olds and 96% of 80-year-olds have disc degeneration on MRI—even if they have no pain. (Brinjikji et al., 2015)

• See here 👉 Disc Bulges Don't Always Mean Pain: What the Science Really Says

This can lead to fear, anxiety, and avoidance of movement, which actually worsens pain and disability.

2. It Can Trigger a Cascade of Unnecessary Treatments

Seeing “abnormal” findings on an MRI can set off a chain reaction of unnecessary interventions, including:

• Overuse of painkillers (including opioids).

• Corticosteroid injections that may provide only temporary relief.

• Surgery for findings that may not be the real cause of pain.

Each step increases healthcare costs, potential complications and—most importantly—can delay natural recovery.

3. It Reinforces a Biomedical View of Pain (Instead of a Biopsychosocial One)

Many patients (and even clinicians) still believe that pain always means tissue damage—but modern pain neuroscience tells us otherwise.

Pain is influenced by multiple factors beyond structural damage, see here for more on this 👉 Pain Does NOT Equal Damage: The Neuroscience Behind Chronic Pain

Early MRI reinforces the outdated belief that pain is purely mechanical, leading patients to fixate on scan results rather than focusing on rehabilitation, movement, and self-care.

Conclusion: Less Imaging, Better Outcomes

While MRIs can be a valuable diagnostic tool when used appropriately, Webster et al.’s research highlights a crucial point: for most cases of low back pain, early imaging does more harm than good.

Rather than jumping to an MRI, we need to shift our focus to a thorough assessment including screening for serious pathology, education and movement tailored to the individual.

References

• Webster, B. S., Bauer, A. Z., Choi, Y., Cifuentes, M., & Pransky, G. S. (2013). Iatrogenic consequences of early magnetic resonance imaging in acute, work-related, disabling low back pain. Spine, 38(22), 1939–1946. https://doi.org/10.1097/BRS.0b013e3182a42eb6

• Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. American journal of neuroradiology, 36(4), 811–816. https://doi.org/10.3174/ajnr.A4173