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Imaging for low back pain without serious underlying conditions does not improve clinical outcomes

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The routine use of radiography, MRI or CT scans in patients with low back pain but no indication of a serious underlying condition does not improve clinical outcomes, according to a recent study.

In light of the findings, physicians should refrain from routine, immediate scanning unless they observe features of a serious underlying condition, Roger Chou, MD, of the Oregon Health and Science University in Portland, Ore., and colleagues reported in this week’s edition of The Lancet.

Researchers performed a meta-analysis of randomized controlled trials that compared immediate back imaging — using either radiography, MRI or CT — with usual clinical care that does not involve immediate imaging.

Investigators included six trials that involved more than 1,800 patients and reported a range of outcomes, including pain and function, quality of life, mental health, overall patient-reported improvement and patient satisfaction. The researchers identified no significant differences between immediate imaging and usual clinical care in their meta-analysis, according to a press release.

“Rates of utilization of lumbar MRI are increasing, and implementation of diagnostic imaging guidelines for low back pain remains a challenge,” the researchers said in the press release. “However, clinicians are more likely to adhere to guideline recommendations about lumbar imaging now that these are supported by consistent evidence from higher-quality randomized controlled trials.

“Patient expectations and preferences about imaging should also be addressed, because 80% of patients with low back pain in one trial would undergo radiography if given the choice, despite no benefits with routine imaging,” they said in the press release.

According to Chou, educational interventions could be effective for reducing the proportion of patients with low back pain who believe that routine imaging should be done.

“We need to identify back pain assessment and educational strategies that meet patient expectations and increase satisfaction, while avoiding unnecessary imaging,” he said in the press release.

Reference:

• Chou R, Fu R, Carrino JA, et al. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009; 373(9662):463-472.