The association between lumbar MRI exposure and pain interference and pain self-efficacy in adults with chronic non-specific low back pain who did not respond to pain education: a cohort study

BACKGROUND: Clinical guidelines advise against routine lumbar MRI for chronic non-specific low back pain (CNSLBP) due to limited diagnostic utility and potential psychosocial harm. However, patients frequently seek imaging for reassurance, particularly when first-line guideline-recommended pain education (PE) has not produced meaningful benefit.

AIMS: To explore whether MRI, delivered with clinically framed reporting and multimodal communication, is associated with changes in pain interference and pain self-efficacy in adults with CNSLBP who did not demonstrate a clinically meaningful response to PE.

METHOD: A prospective within-participant observational study was conducted within a specialist spinal service. MRI exposure was conceptualised as a communication process incorporating pre-MRI education and verbal, visual, and written explanation of findings. Adults with CNSLBP who completed PE without clinically meaningful improvement were included. Outcomes were collected pre-PE (Stage 1), post-PE (Stage 2; analytic baseline), and post-MRI communication (Stage 3). Primary outcomes were the Pain Interference Questionnaire (PIQ) and the Pain Self-Efficacy Questionnaire (PSEQ); secondary outcomes included the Pain Severity Questionnaire (PSQ) and global perceived change.

RESULTS: Fourteen participants completed all stages with no missing data. Following MRI communication, PIQ scores improved by −18.79 (95% CI −29.87 to −7.70; p=0.003; dz=0.98) and PSEQ scores improved by +17.93 (95% CI 6.03 to 29.83; p=0.007; dz=0.87). Most participants exceeded clinically important improvement thresholds for PIQ (78.5%) and PSEQ (64.3%). Pain severity showed modest, statistically uncertain change (−4.64; p=0.096). Improvements in self-efficacy were inversely associated with reductions in pain interference.

CONCLUSION: In adults with CNSLBP who had not responded to first-line PE, MRI delivered with clinically framed, multimodal communication was associated with improved function and confidence despite minimal change in pain severity. The findings suggest that the psychosocial impact of MRI is context dependent and that MRI may function as a secondary reassurance intervention for selected PE non-responders. Given the observational design, causal inference is limited.