Unnecessary Lower Back Pain Treatment Tests

Imaging scans for lower back pain treatment are often unnecessary and may do more harm than good, according to new practice guidelines by the American College of Physicians.

In the first of a series of papers designed to help physicians and patients identify costly and unnecessary medical treatments, the ACP advises that x-rays and CT or MRI scans “should be reserved for selective high-risk patients who have serious symptoms.”  In many cases, notes Dr. Amir Qaseem, director of clinical policy in medical education at the ACP, effective lower back pain treatment can consist of a simple medical history and over-the counter pain killers.

Lower back pain is a common ailment that is usually caused by strain on bones, muscles, and ligaments. Though sometimes severe, it usually abates within a few days to a month. Patients suffering from lower back pain are often exposed to a series of tests before doctors can make a diagnosis or prescribe treatment.

According to the ACP, a national organization of internists, studies have shown that tests such as MRIs and x-rays are beneficial only if the pain worsens after initial lower back pain treatment, or if patients show signs of nerve damage or other serious medical conditions. These signs may include weight loss, fever, loss of feeling in the legs, or abnormal reflexes.

Aside from increased healthcare costs for the patient, x-rays and scans may also expose patients to unnecessary levels of radiation, which can increase their risk for cancer over time. In addition, well-meaning doctors looking for an explanation for the pain may take drastic steps – including unnecessary surgery – to address unrelated changes in the spinal bones or spaces between vertebrae seen on scans and images. Surgery as a form of lower back pain treatment is appropriate in only a few such cases, notes the ACP.

Often, doctors perform these tests because patients expect them as part of their diagnosis, and it is easier to order the scans than to convince patients that the tests have no value. The ACP notes that patients with lower back pain need more information in order to understand why the tests are not needed and may even be harmful. Doctors and patients should discuss lower back pain treatment options such as medications and self care, including heating pads and exercises for lower back pain.


Radiology Tests for Patients With Low Back Pain: High-Value Health Care Advice From the American College of Physicians, Annals of Internal Medicine; February 1, 2011

American College of Physicians Issues Advice for High-Value Health Care for Diagnostic Imaging for Low Back Pain

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