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Experts Issue Guidelines on Treating Low Back Pain

One recommendation: MRIs, other scans aren't always helpful

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TUESDAY, Oct. 2, 2007 (HealthDay News) -- Primary care doctors shouldn't routinely order MRIs, CT scans and other diagnostic tests for patients with nonspecific low back pain, according to new joint guidelines released by the American College of Physicians and the American Pain Society.

The guidelines, which are published in the Oct. 2 issue of the journal Annals of Internal Medicine, include a method to guide primary care doctors and other clinicians in gathering and interpreting information during a patient's first visit. This formula would place them in one of three general categories:

  • Nonspecific low back pain, which affects about 85 percent of patients.
  • Back pain potentially associated with spinal conditions, such as spinal stenosis, sciatica, or vertebral compression fracture.
  • Back pain potentially associated with another specific cause, such as cancer.

According to the new guidelines, doctors should not routinely order imaging or other diagnostic tests such as MRIs, CAT scans, or X-rays for patients with nonspecific low back pain. Such tests should be reserved for patients with severe or progressive neurological deficits or suspected underlying conditions such as infection or cancer.

The panel of experts who developed the guidelines also reviewed evidence on drug therapies and non-drug treatments for acute and chronic low back pain.

"Almost all medications reviewed had some benefits, but they have risks," guidelines co-author Roger Chou, head of the American Pain Society Clinical Practice Guidelines Program, said in a prepared statement. "Acetaminophen, for example, is very safe but might not be effective. NSAIDs have gastrointestinal and cardiovascular risks. Opioids and muscle relaxers can provide relief for those with severe pain, but their potential benefits and risks should be weighed carefully."

"Patients who prefer not to take medication can benefit from non-drug treatments, such as acupuncture, spinal manipulations and massage therapy. None, however, are proven to be more effective than others to warrant recommendation as first-line therapy," Chou said.

More information

The U.S. National Institute of Neurological Disorders and Stroke has more about low back pain.

SOURCE: American College of Physicians, news release, Oct. 1, 2007

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