0
Summaries for Patients |

Radiology Tests for Patients With Low Back Pain: High-Value Health Care Advice From the American College of Physicians FREE

[+] Article and Author Information

The full report is titled “Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care From the American College of Physicians.” It is in the 1 February 2011 issue of Annals of Internal Medicine (volume 154, pages 181-190). The authors are R. Chou, A. Qaseem, D.K. Owens, and P. Shekelle, for the Clinical Guidelines Committee of the American College of Physicians.


Ann Intern Med. 2011;154(3):I-36. doi:10.7326/0003-4819-154-3-201102010-00002
Text Size: A A A

Who developed these recommendations?

The American College of Physicians (ACP) developed this advice. Members of ACP are internists, specialists in the care of adults.

What is the problem and what is known about it so far?

Low back pain is common and is usually due to strain on bones, muscles, and ligaments (that is, musculoskeletal). Musculoskeletal low back pain can hurt a lot but usually goes away after a few days to a month. Sometimes, medications and exercises are helpful. Studies have shown that radiology tests (x-ray, computed tomography, or magnetic resonance imaging) are beneficial only if the pain worsens despite initial care or if patients have signs of nerve damage or a serious medical condition. Such signs include weight loss, fever, abnormal reflexes, or loss of muscle power or sensation in the legs. Although most patients with low back pain do not need radiology tests, many patients get them.

Is there any benefit of routine radiology tests in patients with low back pain who do not have features associated with serious conditions?

Routine radiology tests have no benefit for musculoskeletal low back pain. Six good studies that compared routine radiology tests with no testing for patients with musculoskeletal low back pain showed that patients did about the same regardless of whether they got the tests. Some studies even suggested that patients did better without routine testing.

What is the harm of ordering radiology tests in patients with low back pain who do not have features associated with serious conditions?

Tests often show changes in the spinal bones (vertebrae) or the spaces between the vertebrae (discs). These findings are often not the cause of the low back pain and are common in persons without back pain. However, doctors and patients often feel they must do something, such as back surgery, when these findings are present. Many patients are then exposed to the risks of surgery even though it is appropriate only in very few patients with back pain. Radiology tests also expose patients to radiation, which may over time increase their risk for cancer.

Why are so many unnecessary imaging tests done for low back pain?

Patients often expect testing when they see a doctor, assume that more tests mean better care, or are dissatisfied when no tests are done. It can be easier for doctors to order a test than to explain why it has no benefit. Some doctors also worry about being sued if they do not order tests.

What does the ACP suggest that patients and doctors do?

Doctors should use a patient's history and physical examination to determine whether the low back pain is musculoskeletal or due to a serious condition.

Doctors should not order x-ray, CT, or MRI unless they suspect a serious cause of low back pain.

Patients with musculoskeletal low back pain need information so that they understand why they do not need tests even though their backs hurt.

Doctors and patients should discuss the expected course of low back pain; the importance of remaining active; medications for pain and inflammation; and self-care options, such as heating pads, exercise, and other nondrug treatments.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)