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Medical Imaging and Pain

By Erik Bies, DPT, MS

I recently came across an acronym I’d never seen or heard before; thanks to Twitter believe it or not…VOMIT! Seriously, that was the term. VOMIT or (Victim of Medical Imaging Technology) was first coined in the British Medical Journal in 2003 by Richard Hayward. In his article, he discusses the anxiety that medical imaging can cause patients and their families. A link to the article can be found here.
VOMIT (victims of modern imaging technology) — an acronym for our times

Do we really know the source of pain by looking at an image? Evidence suggests that we cannot look at an image and point to the source of pain. For example when a patient presents to physical therapy with low back pain and an MRI report indicating a “bulging disc,” It has to be questioned whether this is an anatomic source of pain or is it an incidental, non-threatening finding. Research indicates that in 20-22 year olds without low back pain, 25% have a bulging disc and 50% show other degenerative changes.2 A study of adults older than 60 years old with no report of shoulder pain revealed that up to 50% have rotator cuff tears.3 Similar findings of asymptomatic body parts showing degenerative changes including knee arthritis, cervical spine degenerative changes, ankle and foot bone spurs are also common in the medical literature.

Why am I bringing this up? The issue is that pain is more complex than imaging detecting “degenerative tissues,” and our role as medical professionals is not to make you anxious, but to reduce your pain and improve your function. In a previous newsletter article, Nate Hadley DPT, provided excellent background regarding how psychosocial factors including fear of movement and anxiety increase our perception of pain.

We all want answers, but imaging does not always give us straightforward answers. It is a valuable tool to complement other objective and subjective data to piece together a patient problem. The point is, even if you have evidence of degenerative joints, a bulging disc, arthritis, or a rotator cuff tear, your pain is not necessarily the direct result. Don’t be a VOMIT.

BMJ 2003;326:1273 (7 June), doi:10.1136/bmj.326.7401.1273)
Takatalo J, et al. Prevalence of degenerative imaging findings in magnetic resonance imaging among young adults. SPINE; 2009 34(16): 1716-1721.
Sher JS, et al. Abnormal findings on magnetic resonance images of asymptomatic shoulders. (1995) J Bone Joint Surg Am; 1995 77(1): 10-15.