I’ve been having low back pain off and on for years. The last two years have been the worst. I’ve been seeing a chiropractor who adjusts my low back for me. The X-rays taken as part of my evaluation show significant degeneration of the lumbar spine. I’m just wondering if it wouldn’t be worth it to have some better imaging studies done. Would MRIs or CT scans provide us with a better idea of what’s going on down there?

Experts in this area suggest that computed tomography (CT) scans may offer the best way to see changes in the facet (spinal) joints of the low back area. But the knowledge gained from the more advanced imaging study may not change your treatment.

That’s because there’s still no proof that degenerative, arthritic changes in the facet joints has anything to do with back pain. There are simply too many people with severe changes seen on imaging studies who don’t have any back pain at all.

It makes sense that if osteoarthritis of the facet joints was the cause of low back pain, then anyone with moderate-to-severe degenerative changes would have the same painful symptoms. But they don’t and that’s what has many doctors scratching their heads.

Even more confusing is the fact that some patients get relief from facet joint blocks. The surgeon injects a numbing agent and steroid into the facet joint area, providing pain relief for the patient. This treatment suggests some involvement at the facet joint. But whether that’s really a placebo (the patient expects the treatment to work, so it does) or some other factor remains to be proven.