Imaging for Low Back Pain Often Useless, Harmful
American College of Physicians questions value, benefit, cost
TUESDAY, Feb. 1 (HealthDay News) -- For most patients, routine imaging for low back pain is an expensive intervention that may do more harm than good, according to a clinical guideline published in the Feb. 1 issue of the Annals of Internal Medicine.
Roger Chou, M.D., of the Oregon Health & Science University in Portland, and colleagues consulted a joint clinical practice guideline from the American College of Physicians and the American Pain Society as well as a meta-analysis to compile recommendations regarding the use of diagnostic imaging methods for low back pain. They write that six studies showed that patients with low back pain who underwent routine radiology tests fared about the same as patients who underwent no testing, with some studies even suggesting patients fared better without routine testing. They note that findings on these tests were often not actually the cause of the low back pain but were treated anyway, often with surgery.
The authors recommend that physicians use a patient's history and physical exam to determine whether back pain is musculoskeletal or caused by a skeletal condition and that they order an X-ray, computed tomography, or magnetic resonance imaging only if they suspect a serious cause of back pain. They also write that doctors should explain to patients why they do not need to undergo tests and discuss options with them. In a related guideline in the same issue, the authors discuss the challenge of reducing the increase in health costs while preserving high-value, high-quality care, and introduce three concepts for understanding the assessment of value in health care interventions.
"Implementing a selective approach to low back imaging, as suggested by the American College of Physicians and American Pain Society guideline on low back pain, would provide better care to patients, improve outcomes, and reduce costs," Chou and colleagues write.
Several authors of the first article disclosed ties to health benefits companies.