X-Rays Often Meaningless for Arthritis and Back Pain

Published: October 9, 2012
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X-Rays, MRIs and CT Scans:Radiologists Love Them … But They're Often Meaningless!

We've known for decades that spinal x-rays, MRIs and CT scans add very little information about back pain.

They most often don't tell doctors whether the pain is coming from the spine or from disc, arthritic, or bone disease (though they may reveal if the problem can be fixed with a chiropractic adjustment.)

Research also shows that, if back pain is present, radiologists tend to interpret x-ray results as confirming the presence of a host of horrific (and scary-sounding) problems. Yet remarkably, if those same radiologists are shown x-rays and MRIs from both healthy people and those with back pain, they can't tell one group from the other!

Nonetheless, doctors continue to scare people by telling them how horrible their x-rays look. And they continue to operate on people based on those x-rays — even though the x-ray results are often meaningless, with much of the back pain coming from muscular and ligament problems that are totally reversible without surgery.

The same folly applies to x-rays for arthritis. An exception? X-rays for rheumatoid arthritis may show the scope of, and severity of, the disease, and help guide how aggressive the needed therapy should be.

Now, a new study shows the same type of radiological "madness" for TMJ/jaw joint dysfunction — with doctors reaching conclusions that simply aren't true, and unnecessarily operating on people based on these! Here is yet another study showing that x-rays simply do not tell if the jaw joint is the source of jaw pain. And, here's a very practical way to protect yourself from unnecessary procedures based on mistaken conclusions.

In the study, CT scans of the jaw joint showed that bony/arthritic changes on CT scan were very poorly correlated with pain and other clinical signs and symptoms of TMJ. To put it more bluntly: the x-ray changes were mostly meaningless!

But that didn't stop doctors from showing many patients the x-rays … telling them they had jaw joint problems … and recommending surgery to relieve their symptoms. Scary!

The good news is that more often the pain comes from tight jaw muscles such as the masseter muscles, which can generate as much as 1,000 pounds of pressure per square inch during chewing. And it's easy to tell if the pain is coming from the muscle rather than the joint. Here's how:

  1. Put your thumb in the side of your mouth, aiming the tip of your thumb at the ear on the side that hurts.
  2. Put your index finger over your outer cheek, pressing it against the tip of your thumb.
  3. Using your thumb, find the area of your cheek where it gives way to a thicker area of muscle, about two inches wide, in front of your ear.
  4. Squeeze up and down that thickened area between your thumb and index finger, pressing hard.

If it hurts like the dickens, reproducing the TMJ-type pain, it proves the pain is coming from the muscle — not the joint. For relief, the muscle simply needs to be released.

The S.H.I.N.E. Protocol helps a lot with that release. So does applying a product called Nerve Pain Gel topically over the muscle, 3 times a day, for 3 to 4 weeks. (Then use it as needed.) The gel is available by prescription from ITC Pharmacy. Your doctor can call in the prescription to be mailed to you, and speak with the pharmacist to get more information on the gel.

In addition, remember that natural herbal mixes, such as an herbal supplement that provides relief for muscle pain (with boswellia and white willow bark; or curcumin, boswellia, nattokinase, and DLPA), can be dramatically beneficial for most kinds of pain!

On the upside, jaw muscles seem to be involved with "setting" tension in other muscles throughout the body. So when jaw muscles start to relax, other pains often go away as well!

Below is an abstract of the new study, so you can take a look at it for yourself.

Study Abstract

Objectives

The purpose of this study was to determine whether bony changes in temporomandibular joint (TMJ) osteoarthritis (OA) is correlated with pain and other clinical signs and symptoms.

Methods

Clinical data and cone beam CT (CBCT) images of 30 patients with TMJ OA were analysed. The criteria of Koyama et al (Koyama J, Nishiyama H, Hayashi T. Follow-up study of condylar bony changes using helical computed tomography in patients with temporomandibular disorder. Dentomaxillofac Radiol 2007; 36: 472-477.) and Ahmad et al [Ahmad M, Hollender L, Anderson Q, Kartha K, Ohrbach R, Truelove EL, et al. Research diagnostic criteria for temporomandibular disorders (RDC/TMD): development of image analysis criteria and examiner reliability for image analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107: 844-860.] were used to classify the condyles observed on the CBCT. Clinical measures included self-reported pain, mandibular range of motion, TMJ sound, pain on palpation of the TMJ and masticatory muscles, and pain on jaw function. Generalized linear modelling was used to correlate the clinical and radiographic findings and Spearman's rho was used to correlate the two classification systems.

Results

There was poor correlation between the maximum condyle change and pain rating (Koyama: r(2) = 0.1443, p = 0.3995; Ahmad: r(2) = 0.0273, p = 0.9490), maximum mouth opening (Koyama: r(2) = 0.2910, p = 0.0629; Ahmad: r(2) = 0.2626, p = 0.0951), protrusion (Koyama: r(2) = 0.0875, p = 0.7001; Ahmad: r(2) = 0.1658, p = 0.3612), right lateral motion (Koyama: r(2) = 0.0394, p = 0.9093; Ahmad: r(2) = 0.0866, p = 0.6877) and left lateral motion (Koyama: r(2) = 0.0943, p = 0.6494; Ahmad: r(2) = 0.1704, p = 0.3236). Strong correlation was observed between Koyama et al's and Ahmad et al's classifications for average (r = 0.9216, p < 0.001) and maximum (r = 0.7694; p < 0.0001) bony change.

Conclusions

There was poor correlation between condylar changes (as observed on CBCT images), pain and other clinical signs and symptoms in TMJ OA.

Resources

"Correlating cone beam CT results with temporomandibular joint pain of osteoarthritic origin."Palconet G, et al., Center for Neurosensory Disorders, University of North Carolina at Chapel Hill School of Dentistry, Dentomaxillofac Radiol. 2012 Feb;41(2):126-130. Epub 2011 Nov 24.

 
Jacob Teitelbaum, MD

is one of the world's leading integrative medical authorities on fibromyalgia and chronic fatigue. He is the lead author of four research studies on their treatments, and has published numerous health & wellness books, including the bestseller on fibromyalgia and chronic fatigue syndrome From Fatigued to Fantastic! and his newer The Fatigue and Fibromyalgia Solution.  Dr. Teitelbaum is one of the most frequently quoted fibromyalgia experts in the world and appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and Fox News Health. 

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