Negative Imaging

Although it seems - and I state this cautiously - that we collectively are improving our awareness of the role of diagnostic imaging in "painful" presentations, a recent encounter with an athlete reminded me of a different role.

The literature states that the correlation between positive findings on imaging studies and chronic pain presentations are likely weak at best but reality seems to state that patients still often search for that tangible finding that confirms their "pain".

There are many causes of this I know, one of which is the "Nocebo" effect through clinician-patient communication, but I was recently reminded of a potential positive effect of an unremarkable or "normal" diagnostic imaging study.

Let me frame this for you:

• Athlete comes in experiencing pain
• Athlete states that she is scheduled for an MRI
• From your history and physical examination, you deduce that this MRI likely will not "find" anything
• Rather than step on the other physician's toes, you decide to keep quiet and both directly and indirectly explain "Why Things Hurt" through and during your clinical intervention
• MRI results come back negative
• Athlete immediately reports that their feeling and moving better

While I cannot explain the exact mechanism for this, I did ask Jason Silvernail if there was a term for this phenomenon. He wasn't aware of one but did state through our brief discussion that there was a "credible reduction of threat".

Perhaps Fabrizio Bennedetti knows? He studies the neurobiology of placebos so while this isn't specifically a placebo or nocebo effect per se, maybe we can call it a "procebo"?

Now, I'm certainly not advocating the use of diagnostic imaging for this purpose. However, this phenomenon does certainly interest me and do wonder what the literature says, if anything at all.

In the meantime, if you're interested in what Dr. Bennedetti has to say, I recently listened to a great podcast with he and Dr. Ginger Campbell.