Imaging of Low Back Pain Fails to Change Outcomes

FRIDAY, Feb. 6, 2009 (HealthDay News) -- Using medical imaging on people who have low back pain that has no apparent underlying cause doesn't improve clinical outcomes, a new study finds.

This means that doctors should not conduct routine MRI, CT or radiography unless they see signs of a serious underlying condition, the authors say.

Dr. Roger Chou, of the Oregon Health & Science University in Portland, and colleagues reviewed the findings of six trials that included more than 1,800 participants. The analysis of a wide range of outcomes -- including pain and functioning, quality of life, mental health, overall improvement and patient satisfaction -- showed no differences between patients who received immediate imaging and those given usual clinical care.

The results apply most strongly to patients with acute or sub-acute low back pain assessed in a family doctor's office, said the study, published this week in The Lancet.

"Rates of utilization of lumbar MRI are increasing, and implementation of diagnostic-imaging guidelines for low back pain remains a challenge," the researchers wrote. "However, clinicians are more likely to adhere to guideline recommendations about lumbar imaging now that these are supported by consistent evidence from higher-quality, randomized, controlled trials."

Patient expectations and preferences also need to be addressed, they said, citing one study of people with low back pain in which 80 percent of the participants said they would have imaging, if given the choice, even without expected benefits.

"We need to identify back-pain assessment and educational strategies that meet patient expectations and increase satisfaction, while avoiding unnecessary imaging," the researchers wrote.

But certain factors may interfere with doctors' attempts to avoid immediate imaging in people with low back pain, Michael M. Kochen, a professor at the University of Göttingen in Germany, and his colleagues wrote in an accompanying editorial.

These roadblocks might include "patients' expectations about diagnostic testing, reimbursement structures providing financial incentives, or the fear of missing relevant pathology."

More information

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