Do all causes of chronic back pain show up on imaging tests like an MRI?

Not all causes of chronic back pain appear on imaging tests such as an MRI. While an MRI can provide detailed images of the spine and assist in identifying many structural issues, in the majority of chronic back pain cases, it cannot pinpoint the exact cause of the pain [4].

It is common to see age-related changes in the discs and joints in people who suffer from back pain as well as those who do not. This means that the presence of these findings on an MRI scan does not necessarily mean they are the cause of the pain [4].

When is an MRI useful?

An MRI is a powerful diagnostic tool for detecting many structural problems that may cause back pain. An MRI can reveal herniated discs, spinal stenosis, vertebral fractures, tumors, and infections affecting the bones or spinal discs [2]. It is also useful in evaluating ligament and tendon injuries.

An MRI is not routinely ordered for back pain, but it may be considered if symptoms persist for more than six weeks without improvement, or when specific clinical indicators (red flags) are present that suggest a potentially serious problem [5].

Causes of back pain that may not show on an MRI

There are several causes of chronic back pain that may not be apparent on MRI scans, or they may be present but not the primary cause of the pain. These causes include:

• Non-specific low back pain: This is the most common type of back pain, where the exact cause cannot be diagnosed in most cases [4].
• Muscle and ligament strain: Straining the muscles or ligaments in the back can lead to chronic pain, and this type of injury often does not show clearly on imaging tests [2].
• Fibromyalgia: A condition characterized by widespread pain and fatigue; back pain may be a part of it, and this condition does not show up on imaging tests [2].
• Other medical conditions: Conditions such as kidney stones or infections, or endometriosis in women, can cause back pain that does not appear on an MRI of the spine [2].
• Psychosocial factors: Stress, depression, and anxiety can play a role in worsening or sustaining chronic back pain, and these factors cannot be detected by imaging [4].

When should you seek immediate medical attention?

You should seek immediate medical attention if back pain is accompanied by any of the following symptoms, known as red flags:

• Loss of bladder or bowel control [4].
• Numbness around the genitals or the anal area [4].
• Increasing weakness or numbness in both legs [4].
• Fever or unexplained weight loss [4].
• A history of cancer or a recent injury [4].

For more comprehensive information on chronic back pain, you can visit the page Chronic Back Pain: Causes, Diagnosis, and Treatment (Arabic).

Medical references

• Low back pain - Overview | Guy's and St Thomas' NHS Foundation Trust
• Back Pain
• Back pain | CUH