My mother has had a bothersome right knee for years; she always made light of it and refused to go to the doctor over it though. But sometime in the beginning of this year she learned that she could hear it click and snap painfully whenever she would try to straighten up. She finally relented and sought medical opinion; she found out that this wasn’t something she could have over with in a day or two. An MRI showed her that the problem was torn knee cartilage. The doctor, seeing the torn cartilage, felt that to repair the damage, her only hope was knee surgery. The thing is, the MRI did show her doctor exactly what was wrong; it didn’t help her interpret the results though. It turned out that my mother had arthritis; arthritis pain relief doesn’t come through surgery. Interpreting scans correctly is becoming a bit of a challenge these days; the scans show such detailed pictures of an area that doctors lose themselves in the visuals of it, and forget their training.
Just because you can see something abnormal on a scan, it doesn’t mean that the abnormality is the cause of the problem the patient complains of. Doctors often own their own scanners, and ask their patients to get one done all the time. Even with Medicare, patients pay about $1000 a scan; it turns out to be very profitable for the doctors, and a miserable choice for the patients. Not that the patients are reluctant to get them done either; there is a certain attraction to the idea of getting a scan done; it looks like it’s a window into your problems. But if you go in with a painful knee, all that an MRI usually does these days is to show up a bunch of irrelevant abnormalities, that could distract the doctor from the real problem – which is finding a way to achieve arthritis pain relief.
No one’s actually ever studied closely what an MRI of a normal person looks like. When something shows up on an MRI that looks like an abnormality, doctors have no idea how to tell an abnormality from a normal structure. Doctors wonder at all the stuff on an MRI that looks abnormal, and right away recommend surgery or something, that turns out to be catastrophic. It just leads to a lot of misery for all concerned. My mother learned that her problem was simply arthritis, and the torn cartilage didn’t actually mean anything. She needed a few simple drugs to achieve her arthritis pain relief. If you are going to have a problem that needs an MRI, you had better pray that your problem is either in your knee or your back. Those are the only parts of the body that doctors know well enough to tell what is abnormal.
A recent large-scale study on knee pain finds for instance, that torn cartilage that looks pretty abnormal, usually has nothing to do with the pain. People with pain-free knees have torn cartilage too. If you went in for surgery to repair torn cartilage, it would not do anything for your painful situation. A tear in an old person is not the same thing as one in a young person. In an older person, a tear of the knee cartilage is just a part of growing old. The same applies for the spine. Doctors used to look at scans of the spine and look at a lot of structures that looked abnormal; there would be herniated discs, degenerative changes and so on. The doctors would worry that they needed to operate on everything they saw like that. It turns out that all these are normal in old people, and are usually pain-free. Usually because herniated discs self-repair. The doctors now are beginning to rethink the way they look at these things. They need to focus on arthritis pain relief, spinal pain relief, backache relief; they need to look at the specific reason behind it. And MRIs don’t really help with that.
So the medical community is proposing a new way in which to study MRIs and other scans. If an abnormality shows up in one, the radiologist is supposed to place it in context by providing information that speaks of how many times it’s been found that the abnormality in question is actually known to cause any pain.