It’s hard to trust an individual – it’s easier to trust an image

The paradox in back treatment
International guidelines are clear: Routine imaging (X-ray, MRI, CT) for uncomplicated low back pain is rarely necessary and can even be harmful. Yet clinicians experience that many patients insist on having images taken. Why? That question has been explored by researchers from Canada and Denmark in a new qualitative study published in BMC Primary Care.

The patient’s inner narrative
The study shows that imaging for many patients is not just about medical information – it’s about psychological reassurance. Patients associate imaging with:

• Control:An image gives the feeling of “seeing” the problem.
• Validation:“If there’s an image, my pain is real.”
• Reassurance:The fear of missing something serious outweighs concerns about radiation or cost.

As one participant put it: “It’s hard to trust an individual; it’s easier to trust an image.”

The Belief in Imaging – and Its Dynamics
Interestingly, the study showed that patients’ attitudes change over time. At inclusion, the majority were neutral or disagreed that imaging was necessary. But months later, interviews revealed that the picture had shifted: many believed that imaging should have been part of their treatment. This development is due to:

• New symptoms and concerns.
• Input from family, friends, and internet searches.
• Lack of continuous reassurance from the clinician.

The clinician’s role: More than treatment
The researchers conclude that communication is key. When patients feel heard and receive a clear explanation of why imaging is unnecessary, the pressure for unnecessary scans decreases. But the effect is often temporary. Therefore, the study recommends:

• Structured patient education at every visit.
• Use of diagnostic language that does not create fear (avoid words like “degeneration” without context).
• Focus on self-management and prognosis rather than on the absence of imaging.

 Why does it matter?
Overuse of imaging costs billions, increases the risk of overtreatment, and can create unnecessary anxiety. Understanding patients’ psychological needs is therefore crucial to balancing evidence-based practice with patient-centered care. Patients seek images to see, understand, and feel taken seriously. The clinician’s task is to offer the same reassurance – without resorting to unnecessary scans.

Lynn Haslam-Larmer, Kathleen E. Norman, Andrea M. Patey, et al. “It’s hard to trust an individual, it’s easier to trust an image”—patients with low back pain want imaging as a means of coping with uncertainty. BMC Prim. Care 2025.