Is routine imaging for low back pain helpful?

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Lumbacurve imaging for back painWhen it comes to lower back pain, more testing doesn’t lead to better care. On the contrary — it may actually lead to worse care, not to mention higher costs, it was reported by Reuters’ According to a report from the Clinical Guidelines Committee of the American College of Physicians (ACP), there’s “good evidence” that routine spinal imaging for lower back pain patients isn’t associated with meaningful benefits, health wise, and can even lead to harm. It added that diagnostic imaging — with lumbar radiography, computed tomography (CT) or magnetic resonance imaging (MRI) — is needed for patients with lower back pain “only if they have severe, progressive neurologic deficits or signs or symptoms that suggest a serious or specific underlying condition.”

More imaging should take place only on the development of new symptoms or changes in old ones, with imaging in general overused and a major reason for the “high and growing costs” associated with treating lower back pain. “Honestly, it’s not just the cost — we are doing real harms to our patients,” said Amir Qaseem, Senior Medical Associate, Department of Clinical Programs and Quality of Care at ACP, in a telephone interview with Reuters Health. “With unnecessary imaging, patients are not getting good quality care.”

In the paper, which appears in the Annals of Internal Medicine, the committee noted that imaging drives costs higher through the direct cost of the procedures but also whatever results, including additional tests, follow-up, referrals and possible invasive procedures.

“Physicians need to stop ordering these tests and talk to their patients about why they aren’t ordering a test. Most patients don’t want tests that are not beneficial and may be potentially harmful,” Qaseem said. Besides addressing patient expectations and doctor behaviour, the idea of curbing financial incentives for tests also needs to be addressed, he added. “Once you have a CT scanner, you want to use it. Defensive medicine also plays a major role, the worry that I will miss something, but fear of lawyers doesn’t mean that you stop providing good care to the patient.”

(Reporting by Megan Brooks at Reuters Health; editing by Elaine Lies)