Who really does need imaging for low back pain?

You may or may not have read my previous blog about the pros and cons of imaging.  This is a really  important topic for many reasons, not just the financial implications on our health system.  Hopefully it might have opened your eyes a little to how imaging can be really unhelpful in some circumstances.

It is easy to see how there can be a difference of opinion between a physio or GP and the sufferer of low back pain about whether imaging is needed.

In fact, talk to any GP and they will tell you how tricky it can be when someone has an expectation that unless they have an XRay or MRI, they won’t be satisfied.

In fact, a recent Australian study revealed that most people experiencing acute low back pain expect imaging, believing it will identify the cause of their pain and so was considered a prerequisite for effective care (Hoffman et al, 2013).

However, these views conflict with the available evidence on imaging (for a full list of references of the available evidence, check this page out)

So here is the current recommendation by the Australian Physiotherapy Association, as part of the Choosing Wisely initiative and NPS MedicineWise.

Don’t request imaging for patients with non-specific low back pain and no indicators of a serious cause for low back pain.

Trials have consistently shown that there is no advantage from routine imaging of non-specific low back pain, and there are some potential harms.

Imaging is instead recommended for cases of low back pain where there is a suspicion of an underlying medically serious disease, like cancer or infection.

In people who present to primary care with low back pain, medically serious disease is uncommon.

Patients with a higher likelihood of medically serious disease as the cause of their low back pain can be identified by red flags, like a history of cancer.

By the way, what is Choosing Wisely?

It is a programme led by Australia’s medical colleges and societies, and facilitated by NPS MedicineWise.  Here is the link to the Choosing Wisely website, it is well and truly worth a look about all kinds of investigations and interventions.

Reference:

Hoffmann, T.C., et al., Patients’ expectations of acute low back pain management: implications for evidence uptake. BMC Fam Pract, 2013; 14: 7.

If you have any questions about a low back pain problem, ring us for a FREE Physio Phone Consultation, or a FREE Preassessment in person to get some advice and to see if we can help you.