Can an MRI scan predict future back pain?
What do MRI findings really tell us about future back pain and disability?
An MRI scan can show changes in the discs, joints and bones of the lower back. But does an abnormal-looking scan tell us who will experience pain or disability years later? Research suggests the answer is more complicated than it might appear.
A 2025 systematic review examined 49 studies involving 37 distinct study populations. It explored whether looking at several MRI abnormalities together, rather than one finding in isolation, was more closely associated with low back pain. Many studies reported that a greater burden of abnormalities was associated with more pain or disability. However, the included evidence largely examined people at a single point in time. An association is not the same as predicting an individual's future symptoms.
A separate long-term study followed people who already had chronic low back pain. Of 204 participants scanned at the start, 170 provided follow-up information about 13 years later. Baseline disc degeneration and facet-joint degeneration were not associated with long-term disability in the researchers' adjusted analysis. Some other associations were found, but these should not be treated as reliable individual predictions.
Why does this matter? Disc degeneration and other structural changes can be present in people with and without pain. Conversely, someone can have substantial pain without a dramatic MRI abnormality. Symptoms are influenced by several factors, and the significance of a scan finding depends on the clinical history and examination.
MRI remains valuable when clinicians suspect serious disease, need to investigate particular neurological symptoms, or are considering treatment for which the imaging result could alter decisions. The point is not that scans are unhelpful: it is that they are one part of the assessment, not a crystal ball.
For patients: If your report mentions degeneration, ask whether the finding fits your symptoms, what it means for treatment, and whether it changes the outlook. A scan report alone rarely provides a definitive prognosis.
Original research
- Dragsbæk et al. *European Journal of Pain* (2025). Systematic review of combined lumbar MRI findings: https://doi.org/10.1002/ejp.70076
- Longitudinal 13-year MRI/disability cohort: https://pubmed.ncbi.nlm.nih.gov/32875907/