V.O.M.I.T - Why your doctor may refuse a scan for your back pain!
November 6, 2020
“Above all, watch with glittering eyes the whole world around you. Because the greatest secrets are always hidden in the most unlikely places.” Charlie and the Chocolate Factory, Roald Dahl
I once heard a fellow physiotherapist describe a patient as a V.O.M.I.T – Victim Of Medical Imaging Technology, and, despite how disrespectful I thought it sounded, the premise struck a cord with me. It is something we see too often, and it can be more harmful than people realise. It describes the instance whereby, due to a lack of understanding, a cascade of negative effects will occur, purely because someone has had a scan, or even a scan has merely been suggested!
Let’s paint the scene…
You have back pain and your GP sends you for an MRI. So what happens next?
Firstly, your brain can be immediately bombarded with scary, negative, ‘danger’ thoughts…. because the GP must think there’s something seriously wrong right? ……because scans are only reserved for serious conditions right? In response to all these ‘danger’ messages, your brain gives you some more pain to try to protect you from all these ‘threats’. So, before anything has even been done, your pain can increase!
To add to this, you go to the scan and it shows a disc bulge. Again, the ‘danger’ messages hit you…..my auntie once had a disc bulge and she’s had back pain for years so all disc bulges are really dangerous and only ever end in a lifetime of pain and problems right? Again, the brain gets a little over-protective and pops your pain up some more.
Secondly, you stop moving normally. ….who knows what will happen to your disc bulge if you bend your back or, god forbid, go to the gym?! Because of this fear of movement, your muscles and joints get stiffer, your muscles get weaker and before you know it, back movements get more painful. This is not only because it’s stiffer, but also because your back is just not used to moving any more so it has become highly sensitive to movements that aren’t even a threat. And so, because your brain is now convinced that movement is dangerous, every time you move it gives you even more pain, purely to tell you to stop it!
Thirdly, the actual cause of your pain, which may be something as harmless (but painful, don’t get me wrong!) as muscle spasms, can get missed and ignored while everyone is focussed on the potentially pain-free disc bulge!
What does the research say?
The study that the picture below comes from (and many others studies!) shows that disc bulges (among other findings such as osteoarthritis) are actually common in those who have no pain at all, and are increasingly common with age. In fact, above the age of 50 it is more ‘normal’ to have a disc bulge than to not have one!
So, if you have an MRI and there is a disc bulge, or even arthritis, chances are you’ve had it for years without it causing you a problem, and it’s not even guaranteed to be causing your back pain now!
Patients still come to us shocked that they weren’t offered an MRI for their back pain. This is the very reason why they are no longer recommended, because of the potential for a red herring! You may be distracted from the real cause of your pain by totally innocent (and expected) changes to the joints or discs that show up on a scan.
So to summarise…
In the vast majority of cases, scans for back pain are unhelpful because
1. they exacerbate anxiety and fears, thereby increasing pain,
2. they only show some things, and the cause of most people’s back pain can’t be seen on any scan, and
3. the things scans do show are often natural parts of ageing and can be wrongly blamed, and subsequently wrongly targeted in treatment. For example, things like arthritis and disc bulges (aka slipped discs) are often present without pain!
A non-invasive, thorough musculoskeletal assessment is more likely to determine why you have pain without the need for scans or further investigations in the majority of cases, lowering the risk of you becoming a V.O.M.I.T! The second thing to take from this little ramble of mine, is that even if it is a disc bulge or arthritis that is causing your pain, these things don’t always need to be painful and, at one point, probably weren’t painful at all. Therefore, together with your physiotherapist, you are more than likely able to identify why it started hurting and how to stop it being so painful.