Norman Marcus, MD - Neck and Shoulder Pain - Can an MRI do damage?
I saw a 56 year old office manager, who I will call Roger, with a 5 year history of neck, shoulder and head pain, which had become much worse in the past year. This is the pain diagram he drew. The darkened lines on the shoulder and upper back are where the pain was experienced.
The pain began during a time of great stress in Roger’s life 5 years ago and became much worse when he began to work with a very disagreeable co-worker. When the co-worker was not present, the pain would be almost gone. He had been seen by a number of doctors for his pains and was given a variety of explanations. The pain did not go into the arms as you can see on the diagram but one of the doctors decided nevertheless to get an MRI.
It is important never to forget that the MRI will almost always show some change in the spine and surrounding tissue that mistakenly can be thought to be a reason for your pain. Studiies have shown that up to 40% of patients receiving MRIs have herniated discs, and 70% degenerated discs, without pain. Therefore finding those problems may be misleading. My advice is you shouldn’t have an MRI or CT scan without a suspected specific diagnosis. In other words the MRI should confirm, not make, the diagnosis. In his case he was told that the spine section in his neck (cervical) had spinal stenosis and arthritis. After getting only minimal relief for 1-2 months from epidural steroid injections and facet blocks, he was told he would have to take an anti-inflammatory medication like ibuprofen for the rest of his life, a muscle relaxant for 6 months, and an antiepileptic medication for pain and mood stability. I will have more to say about the dangers of MRIs below-
When I examined Roger I found that he had remarkable flexibility in his neck and shoulders with the exception of a 2 inch deficit in movement of his left shoulder in internal rotation. This suggested to me that there was a specific muscle in the shoulder, the Infraspinatus, which was a possible cause of pain, not arthritis or spinal stenosis. When I tested the muscles in the shoulder and neck with the MPDD I found the Infraspinatus and 5 other muscles to be painful. When I applied topical Ketamine, within minutes the pain was reduced by more than 50%. Roger and I spent the next half hour reviewing how stressful events, and feelings of resentment and fear, consistently caused neck and shoulder pain, and he experienced a further decrease in pain. Does stress bring on your pain?
The MRI not only provided useless information-it was damaging. In addition to adding unnecessary costs to your medcial care, authoritative literature tells us that imaging studies in patients with no suggestion of serious disease, may result in unnecessary treatments and a belief by the patient that they have damage that will always affect them. A very wise internist, Eugene Bauer, said “A word in the mouth of a physician is as dangerous as a scalpel in the hand of a surgeon”. Roger told me that he had spinal stenosis and arthritis and that he would have pain for the rest of his life. Actually the day after our consultation and long discussion, Roger reported that the pain was still relieved by more than half. He asked me to help him find a professional to help manage his stress. Our plan is to deal with stress and tension first and then reexamine Roger to see if the same muscles remain painful and if so treat them with Muscle Tendon Injections.
Norman Marcus, M.D.
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