Your MRI Is Lying to You | The Pained Brain, Chapter 3

Degenerative disc disease · MRI report

What Does Degenerative Disc Disease Mean for Your Numbers?

Degenerative disc disease is one of the most common phrases on a spine report. For most adults it describes a normal spine, and the part that matters sits in blood work and blood vessels the scan never sees.

Your MRI report lists “degenerative disc disease,” and the phrase lands like a diagnosis. So what does degenerative disc disease mean? In most adults it names the ordinary wear a spine collects with years of use: discs that have lost some height, bulges, worn facet joints. It tells you what the tissue looks like. It does not tell you why you hurt, and it says nothing about the blood chemistry and blood vessels that feed that tissue.

Dr. Padda’s video Your MRI Is Lying to You lays out the argument from Chapter 3 of The Pained Brain, written by Dr. Gurpreet Singh Padda, MD, MBA, MHP, and Dr. KrisJay Fucanan, MD. Measura [Cardiometabolic and Autonomic Health Analysis] picks up where the picture stops. The scan shows shape. The question here is which measurements show the terrain around that shape, and why a routine back-pain visit rarely orders them.

What does degenerative disc disease mean when nothing hurts?

Radiologists have been scanning adults without back pain for three decades, and the answer keeps coming back the same. Pooled across 33 studies and 3,110 people with no symptoms, disc degeneration was already present in 37% of twenty-year-olds. By fifty it was 80%. By eighty it was 96%. Bulging discs climbed from 30% to 84% across the same ages, and wear in the facet joints from 4% to 83%.

If most people your age carry the finding and feel fine, the finding cannot be the whole explanation for your pain. Having more wear than your age predicts does not settle it either. Among 382 Japanese community residents, those whose discs looked older than expected reported back pain 17% of the time, and those whose discs matched their age reported it 21% of the time.

How much of your pain can an MRI explain?

Put a number on the link and it shrinks. Across 4,796 adults with arthritic knees, the best MRI-based model could account for no more than 28% of how much their knees hurt, and X-ray features for no more than 15%. Among 180 people already booked for rotator cuff repair, tear length accounted for about 1.2% of their pain. In a large hip cohort, an X-ray showing arthritis had a positive predictive value for hip pain of only 6.0%.

Structure is not meaningless. Inside one body, a badly worn knee hurts more often than the clean knee on the other side. Across different people, though, the same image produces very different pain. In one group of 113 people with knee arthritis, 57 had pain that did not match their X-ray, and those with severe pain but a mild X-ray turned out to have a more sensitive nervous system on formal testing. The camera cannot see how sensitive a nervous system is.

What makes back pain worse without changing the scan?

Several human experiments show pain thresholds shifting across the whole body while the spine stays untouched. Two nights of repeatedly broken sleep lowered heat-pain thresholds in healthy adults, and 34.9% of that change traveled through inflammation produced by their own immune cells. One 37.5-gram glucose drink weakened the nervous system’s ability to turn pain down, more so in people with a higher waist-to-hip ratio. Sleep, sugar and the inflammation they stir up are biological drivers. How people sleep and eat is shaped by work schedules, food environments and stress, which is part of why the same finding behaves so differently from one life to the next.

The most useful of these studies for measurement involved 223 people waiting for knee replacement. Fat mass, measured with bioimpedance, tracked lower pain thresholds at every site tested, including the forehead, which has no arthritis in it. Body mass index tracked none of it. Bioimpedance body composition estimates fat and lean tissue separately, so a normal weight carrying a high share of fat does not get filed as healthy. The difference is explained in body composition, not BMI.

What causes degenerative disc disease besides age?

A spinal disc has no blood supply of its own. It takes in nutrients by diffusion from nearby vessels, so when those vessels narrow, the disc goes hungry. In the Framingham cohort, calcification of the abdominal aorta at a given level predicted breakdown of the disc served by that level 25 years later, with an odds ratio of 1.5. In a pooled analysis of 2,881,170 adults, diabetes came with 1.68 times the odds of degenerated discs. The wear on the report is often a record of the terrain, not only of the years.

A Japanese community study makes the point with two people and one picture. Among residents whose MRI showed the same moderate narrowing of the spinal canal, what separated those with symptoms from those without was not age, sex or body mass index. Diabetes was present in 25.0% of the symptomatic group and 6.4% of the others, and a lower ankle-brachial index also marked the people with symptoms.

Measura does no imaging; the MRI is a different test, done elsewhere. What it can add is the vascular side. An ankle-brachial index compares blood pressure at the ankle with blood pressure at the arm to show how well blood reaches the legs. Arterial stiffness and endothelial function testing describes how the artery wall behaves. Neither photographs a disc. Both describe the circulation that discs and nerves depend on.

What tests should you ask for besides an MRI?

Scans have a real job. Among 1,172 people seen in primary care for back pain, 0.9% had a serious cause, most often a fracture, and radiology’s own criteria reserve imaging for warning signs or for pain that has not improved after about six weeks of care. The imbalance runs the other way: 24.8% of primary-care back-pain visits end in imaging, yet a metabolic panel is rarely drawn the same day. The system is built to photograph the spine, not to measure the person.

A practical list to bring to your physician: HbA1c, fasting glucose, triglycerides and HDL cholesterol, which are standard laboratory panels; a body composition measurement rather than body mass index alone; a circulation check if walking brings on leg pain; and an honest answer about how you sleep. Results go to your physician, who reads them next to your examination and the scan. The study-by-study evidence is in the book companion for Chapter 3, and more prompts are in questions worth asking your doctor.

The picture records where the tissue has been. Blood work and vessel measurements show where it is heading, and they can be repeated to see whether it changes. The hormone upstream of much of this is the subject of high insulin with normal blood sugar.

Frequently asked questions

Is degenerative disc disease actually a disease?

The name suggests one, but the finding is usually part of ordinary aging. Among adults with no back pain it appears in most people past fifty and in nearly everyone by eighty. It becomes meaningful when it matches your history and examination. On its own, the phrase describes the shape of a disc, not the reason you hurt. Chronic pain and metabolic health.

Can Measura testing show what an MRI shows?

No. Measura does no imaging, and an MRI is a separate test done elsewhere. What Measura measures is the terrain around the picture: blood chemistry, body composition, circulation and nerve function. Those describe how the tissue is being fed and how the body is handling sugar and fat, which a scan cannot capture. What a test result can and cannot tell you.

Why would diabetes matter for back pain?

Discs depend on nearby vessels for nutrients, and diabetes affects vessels. People with diabetes have higher odds of degenerated discs, and in one Japanese community study diabetes separated people whose narrowed spinal canals caused symptoms from people whose equally narrowed canals did not. That makes blood sugar and insulin worth checking when back pain does not match the scan. Insulin resistance and metabolic health.

Does the ankle-brachial index have anything to do with the spine?

Indirectly. It measures how well blood reaches the legs, not the spine itself. In a Japanese study of people with moderate canal narrowing on MRI, a lower ankle-brachial index was one of the factors that marked those with symptoms. Leg pain when walking can involve nerves, arteries or both, which is one reason circulation is worth a look. Leg pain when you walk.

Should I skip an MRI my doctor ordered?

No. That decision belongs with your physician, and imaging has a real place when there are warning signs such as a suspected fracture, infection or cancer, or when pain has not improved after weeks of care. The point is to read the picture alongside your examination and your measured numbers rather than by itself. Understanding your results.

Is degenerative disc disease serious?

For most adults, no. The phrase describes ordinary wear that most people past fifty carry without pain. Among 1,172 people seen in primary care for back pain, 0.9% had a serious cause, most often a fracture, and imaging is reserved for warning signs or pain that has not improved after about six weeks of care. What deserves attention is the blood chemistry and circulation that feed the disc.

At what age does degenerative disc disease start?

Earlier than most people think. Pooled across 33 studies of 3,110 people with no back pain, disc degeneration was already present in 37% of twenty-year-olds, 80% of fifty-year-olds and 96% of eighty-year-olds. Bulging discs climbed from 30% to 84% across the same ages. Because the finding is so common in people who feel fine, it cannot be the whole explanation for anyone’s pain.

Can sleep or sugar make back pain worse?

Yes, across the whole body, without changing the scan. Two nights of repeatedly broken sleep lowered heat-pain thresholds in healthy adults, and 34.9% of that change traveled through inflammation from their own immune cells. One 37.5-gram glucose drink weakened the nervous system’s ability to turn pain down, more so in people with a higher waist-to-hip ratio. That is why sleep belongs on the list you bring to your physician.

Measure what the scan cannot show

Ask for a Measura testing plan that adds blood work, body composition and circulation to your imaging history. Results go to your physician.

Send a message

4477 Woodson Rd, Suite 201, St. Louis, MO 63134. Monday to Friday, 9:00 a.m. to 5:00 p.m. Please do not send symptoms, diagnoses or images through a web form — a website form is not a secure medical channel. Send your name and number and we will call you back.

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