Back Pain? Radiography, a CT, or MRI May Not Be Needed
Sun, February 8, 2009 at 03:00AM Existing clinical guidelines for managing low back pain – acute or subacute – recommend against routine imaging exams – radiography, CT scans, or MRI. That doesn’t seem to carry much weight with clinicians, however. Patients’ expectations about diagnostic testing, financial motivation for prescribing these exams, or the fear of missing serious disease are powerful incentives for maintaining the status quo. However, the clinical guidelines have now received support from a large meta-analysis of controlled studies published in The Lancet.
Researchers in Oregon and at Johns Hopkins Hospital analyzed controlled clinical trials that examined the outcomes in patients with low-back pain and no indication of underlying disease. Results in patients were compared for those who had immediate lumbar imaging (radiography, CT, or MRI) versus ‘usual clinical care’ without first imaging. The outcomes were scores for pain or function, quality of life, mental health, and overall patient feedback (improvement and satisfaction with care received).
Six trials met the very strict criteria for this evaluation. There were no significant differences in pain improvement or lumbar function over the 12 months following pain onset between those patients with and without imaging exams. Based on these findings, the experts reiterate that clinicians should refrain from routine immediate lumbar imaging, unless patients present with red-flag features suggesting a serious underlying condition, such as cancer or infection.
So patients with a “hexenschuss” (literally, a shot in the back from a witch) can do their part to reduce healthcare costs by not insisting that they have a work-up involving imaging exams. And family doctors can comply with the guidelines, which are now reinforced.
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