Question
Good day Doctor. I am 27 years old, and was in excellent shape before my problems began. I have had chronic neck pain for about 3 years. X-ray shows no problems. Therapy in the form of medication does nothing. Therapy in the form of manual manipulation, massage, chiropractic care, ultrasound heat, etc., decreases the pain, sometimes to the point of no pain. The problem is that the pain always returns around 4-12 weeks after treatment begins, even with continued therapy. I am wondering, how long should my physician wait before ordering an MRI or other imaging?
I would very much value your insight on my problem. Thank you for your time, Will.

Answer
Hello Will and thank you for sharing your important question with me.  I can relate to your question professionally because I examine about 40 Toronto spinal decompression new patients per week, and many of them have a similar story. 3 years is a long time to not have lasting results. While I am obviously limited in the clinical information you have shared with me it is obvious that greater clarity about your condition is merited seeing that you are still suffering at such a young age.  In Canada where Back Clinics of Canada is headquartered MRI studies are not so easy to come by. It can take sometimes months or longer to have a test performed. In the US it is quite a different matter altogether, a person can have an MRI performed within 24 hours.  You are totally on the right track. I would consult with your doctor and ask him why he hasn't ordered you a MRI yet. If he can't give you a good reason - work with him so he will do so.  MRI tests have the capability of revealing soft tissue you will most certainly get more detailed information with the MRI but it doesn't guarantee that it will reveal your problem.  But, I do agree that it would be wise to do so, in this case.

I am most curious how this will work out. I do sincerely hope you get to the bottom of this quickly so you can obtain the right help you need and start to live a pain free life.  Please keep me posted Will.

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Best wishes,
Dr. Ron Nusbaum