Scanning of patients with back pain questioned

[steaner]

Doctors should refrain from the routine imaging of patients with lower back pain unless they observe serious underlying conditions, a report claims.

The study, published in the Lancet today, suggests the use of radiography, MRI, or CT scans in patients with no indication of underlying conditions does not improve clinical outcomes.

Researchers carried out a meta-analysis of randomised controlled trials that compared immediate back imaging - using one of the three scanning types - with usual clinical care that does not involve instant imaging.

And they found no significant difference between immediate imaging and usual clinical care.

As a result of there being no improvements in clinical outcomes if scanning occurs, the authors recommend that clinicians should refrain from immediate lumbar imaging in patients with acute or sub-acute low-back pain and without features suggesting a serious underlying condition.

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

"Patient expectations and preferences about imaging should also be addressed, because 80 per cent of patients with low-back pain in one trial would undergo radiography if given the choice, despite no benefits with routine imaging.

"Educational interventions could be effective for reducing the proportion of patients with low-back pain who believe that routine imaging should be done."

The authors conclude by stating the need to identify back-pain assessment and educational strategies that "meet patient expectations and increase satisfaction, while avoiding unnecessary imaging".