Is the MRI enough to evaluate chronic lower back pain?

In my opinion, the MRI of the lumbar spine is not the ideal diagnostic tool to evaluate chronic deep midline low back pain. 

There are a few reasons that the MRI is not optimal. If the MRI is interpreted as “normal” or with minimal changes like small disc osteophyte changes or bulges, then there is no “obvious” reason for the low back pain. 

When there is no “obvious” cause for the low back pain three things usually happen: 1) patient is referred to physical therapy, 2) patient is referred to pain management, 3) After seeing a “negative” MRI, the doctor stops looking for the cause of the low back pain because the MRI was negative.

This is terrible news for the patient because they have usually tried physical therapy in the past without resolution of their pain and any injections offered by pain management don’t work for any length of time, if at all. I have talked to many patients who feel they are on a treatment “lazy susan”, going round and round, as they just repeat the above process over and over without relief.

What’s another issue with the MRI of the lumbar spine ? In my opinion, the MRI of the lumbar spine does not image the interior of the disc very well, so internal disc derangement (the real cause of most deep midline, chronic low back pain) is often overlooked, and what problem can be resolved without a good diagnosis ?

Let’s show an example.