Is Immediate Imaging Important to Manage Your Back Pain?

Research shows the frequency patient obtain imaging (X-rays, MRIs, CT scans) varies considerably during the first month of low back pain treatment.^1–3 Current clinical guidelines established by the Agency for Healthcare Policy and Research recommends against imaging during the first month of acute low back pain.^4,5

Why? Imaging is expensive, can be harmful because of radiation exposure, (X-ray and CT scan), does not improve your clinical outcome and risks labelling you with a diagnosis that might not be the cause of your pain ^6,7. It is predicted that two percent of future cancers will be caused by radiation from CT exposure⁸. Furthermore, higher rates of MRI is associated with increased frequency in spine surgery without clear improvements in patient outcomes.^9,10

When To Image

Imaging may be necessary in special circumstances to rule out other conditions which may cause back pain. Tell your healthcare provider if you have recently had a fever or infection, use corticosteroids, experienced significant weight loss, previously had cancer or feel weakness/loss of sensation in the arms, legs or pelvis region.¹¹ Your healthcare provider may also recommend imaging if your back pain does not resolve after a course of physical rehabilitation.

What You Can Do

When experiencing back pain, the first step to recovery is an accurate diagnosis by a practitioner. The American Medical Association recommends patients seek manual therapy (chiropractic and physiotherapy), acupuncture, exercise and back education before seeking surgical alternatives¹². Speak to one of our qualified therapists at about your back
health today.

References:

1. Carey TS, Garrett J, and the North Carolina Back Pain Project. Patterns of ordering diagnostic tests for patients with acute low back pain. Ann Intern Med 1996; 125: 807–14.
2. Cherkin DC, Deyo RA, Wheeler K, Ciol MA. Physician variation in diagnostic testing for low back pain. Who you see is what you get.Arthritis Rheum 1994; 37: 15–22.
3. Di Iorio D, Henley E, Doughty A. A survey of primary care physician practice patterns and adherence to acute low back problem guidelines. Arch Fam Med 2000; 9: 1015–21.
4. Bigos SJ, Bowyer R, Braen R, et al. Clinical Practice Guideline 14.Acute low back problems in adults. US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research (AHCPR); http://www.ncbi.nlm.nih.gov/books /bv.fcgi?rid=hstat6.chapter.25870 (accessed July 21, 2013).
5. Koes B, van Tulder M, Ostelo R, Kim Burton A, Waddell G. Clinical guidelines for the management of low back pain in primary care: an international comparison. Spine 2001; 26: 2504–13.
6. Jarvik JJ, Hollingworth W, Heagerty P, Haynor DR, Deyo RA.The Longitudinal Assessment of Imaging and Disability of the Back (LAIDBACK) study. Spine 2001; 26: 1158–66.
7. Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. N Engl J Med 1994; 331: 69–73.
8. Berrington de González A, Mahesh M, Kim KP, et al. Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med. 2009;169(22):2071–2077.
9. Jarvik JG, Hollingworth W, Martin B, Emerson SS, Gray DT, Overman S, et al. Rapid magnetic resonance imaging vs radiographs for patients with low back pain: a randomized controlled trial. JAMA 2003; 289: 2810–18.
10. Lurie JD, Birkmeyer NJ, Weinstein JN. Rates of advanced spinal imaging and spine surgery. Spine 2003; 28: 616–20.
11. Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, York J, Das A, McAuley JH. (2009). Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain. Arthritis Rheum 60(10) 3072-80.
12. Goodman D, Burke A, Livingston E. Low back pain. JAMA Patient Page April 24, 2013; 309(16): 1738. doi:10.1001/jama.2013.3046.