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AAPM 2025 - 67th Annual Meeting & Exhibition of the American Association of Physicists in Medicine

MRI Screening Scanning Unnecessary for Many Back Pain Patients

By MedImaging International staff writers
Posted on 27 Dec 2011

New findings suggest that routine magnetic resonance imaging (MRI) does nothing to improve the treatment of patients who need injections of steroids into their spinal columns to relieve pain. Moreover, MRI plays only a small role in a physician’s decision to administer these epidural steroid injections (ESIs), the most common procedure performed at pain clinics in the United States.

With greater focus on exploding healthcare costs, the study’s findings, published online December 2011 in the journal Archives of Internal Medicine, highlight one element of the problem: the indiscriminate use of an expensive imaging tool that reveals little clinical benefit.

“Our results suggest that MRI is unlikely to avert a procedure, diminish complications or improve outcomes,” said study leader Steven P. Cohen, MD, an associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine (Baltimore, MD, USA). “Considering how frequently these epidural injections are performed, not routinely ordering an MRI before giving one may save significant time and resources. If we’re trying to cut back on unnecessary medical costs, we should stop routinely doing MRIs on almost everyone who comes to us needing ESIs.” One MRI scanning session costs about USD 1,500.

The patients in Dr. Cohen’s study were all treated at one of several pain clinics in the United States for sciatica, a condition in which the roots of the sciatic nerve that branches out from the bottom of the spinal column is pinched or compressed, causing severe pain and tingling in the lower back that shoots down the leg. The most common treatment in the United States and worldwide is an epidural steroid injection, which places cortisone directly into the outermost part of the spinal canal in the lower back, delivering its anti-inflammatory benefits as close as possible to the source of pain.

Dr. Cohen and his colleagues treated 132 patients split into two groups. Both groups underwent MRI scanning, but the treating doctor only reviewed the films in one group. The first group received epidural steroids with the placement of the needle based only on a physical exam and how and where the patient described his or her pain. The clinicians who examined these patients did not review the MRI before giving the injections, but a physician not involved in the exams or treatments later did. In the second group, physicians determined treatment based on both an examination and imaging results, looking at the MRI to determine where to place the needle and whether to give an injection at all.

After three months, researchers reported no difference in how patients in both groups reported that they felt. In the group whose doctors did not see the MRI scan, 23 (35%) reported “overall success” after three months. In the group whose physicians saw the MRI findings before administering an injection, 24 (41%) reported a positive outcome.

In the first group, whose doctors were not aware of the MRI results, the independent evaluator agreed with the treating doctor in 66% of patients. In 18 of the other 22 cases, the independent evaluator believed an ESI was needed, only in a different location along the bottom of the spine. Dr. Cohen stated that this discrepancy probably did not alter the outcome because research has revealed that the steroid medication reaches across many levels as long as it is injected in the general vicinity. In every case, the physician elected for some type of injection.

In the second group, the treating physician who had the benefit of assessing the MRI findings decided not to perform an epidural steroid injection in only five cases, nevertheless, only to have three of those patients get an ESI within the following six months.

Overall, according to Dr. Cohen, the treatment scarcely varied whether or not MRI was used to guide decision-making. He noted that part of the difficulty in using MRI scanning to diagnose lower back pain is that there is not a good correlation between abnormal findings and symptoms. “If you look at 100 middle-aged people who have never had back pain, two-thirds of them would have abnormalities on MRI,” he stated. “This makes it difficult to use imaging to guide injections.”

People who complain about back and leg pain but have a normal finding on an MRI scan and who go on to get an ESI nevertheless may not get relief because the pain may have originated somewhere other than the spine. Patients with abnormal MRI scans who get ESI also may not receive benefit because their abnormal findings have nothing to do with their pain. In these instances, the abnormal findings are what physicians term a “red herring.”

On the whole, Dr. Cohen emphasized, ESIs are not a magic bullet. Many studies affirm that they provide only short-term benefit to only a subset of people who get them.

Related Links:
Johns Hopkins University School of Medicine

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56 (663.99574279785): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294738616 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

57 (!!!!! 1843.9292907715): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

58 (123.02398681641): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

59 (168.0850982666): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

60 (53.882598876953): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

61 (127.79235839844): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (761.03210449219): SELECT fid FROM jos_deeppockets WHERE id=294738616 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294738616 AND published='1' LIMIT 1

63 (557.89947509766): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

64 (73.909759521484): select jos_twitters.link from jos_twitters where cat=10

65 (31.948089599609): select jos_facebook.link from jos_facebook where cat=10

66 (35.04753112793): select jos_google_plus.link from jos_google_plus where cat=10

67 (36.954879760742): select jos_linkedin.link from jos_linkedin where cat=10

68 (43.869018554688): SELECT fid FROM jos_deeppockets WHERE id=294738616 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294738616 AND published='1' LIMIT 1

69 (48.160552978516): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

70 (378.13186645508): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294738616 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (509.02366638184): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294738616 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (67.949295043945): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (77.962875366211): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (53.882598876953): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (80.108642578125): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294738616 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (41.961669921875): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294738616 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (46.968460083008): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (71.048736572266): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (42.200088500977): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (103.95050048828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

105 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

106 (74.148178100586): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294738616 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (72.002410888672): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294738616 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (78.916549682617): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

109 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

110 (51.975250244141): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294738616 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (591.03965759277): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294738616 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (748.87275695801): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (545.02487182617): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (154.01840209961): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

115 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

116 (89.883804321289): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

117 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

118 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

119 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

120 (90.122222900391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

121 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

122 (306.12945556641): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 22771.835327148): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (528.81240844727): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294738616 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294738616 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 8203.9833068848): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (161.17095947266): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (77.009201049805): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (32.901763916016): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (56.028366088867): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (39.100646972656): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (356.91261291504): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (127.07710266113): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (56.982040405273): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (38.14697265625): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (582.93342590332): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (374.07875061035): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (251.05476379395): SELECT name FROM jos_deeppockets WHERE id=212

138 (43.153762817383): SELECT name FROM jos_deeppockets WHERE id=212

139 (586.98654174805): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (581.02607727051): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

142 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

143 (!!!!! 9719.1333770752): TRUNCATE TABLE jos_trademed_module

144 (130.89179992676): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294738616 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (78.916549682617): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294738616 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (941.99180603027): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (74.148178100586): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (107.0499420166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

149 (65.088272094727): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

150 (!!!!! 1475.8110046387): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (100.13580322266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

152 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

153 (61.988830566406): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294738616 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294738616 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (524.04403686523): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

155 (49.114227294922): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

156 (43.869018554688): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (209.09309387207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

158 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294738616 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294738616 AND published='1' LIMIT 1

159 (42.915344238281): select jos_twitters.link from jos_twitters where cat=10

160 (34.093856811523): select jos_facebook.link from jos_facebook where cat=10

161 (44.107437133789): select jos_google_plus.link from jos_google_plus where cat=10

162 (46.968460083008): select jos_linkedin.link from jos_linkedin where cat=10

163 (351.90582275391): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1090.0497436523): insert into jos_banners_delta values (14615,'2025-06-26 18:04:30','216.73.216.249','view'),(14202,'2025-06-26 18:04:30','216.73.216.249','view'),(14203,'2025-06-26 18:04:30','216.73.216.249','view')

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