Article Discusses the Overuse of Diagnostic Imaging for Chronic Low Back Pain
Low back pain is very common, and many patients receive routine spinal imaging (e.g., CT or MRI), despite evidence-based recommendations to the contrary. For example, one survey showed that 40% of family practice and 13% of internal medicine physicians reported ordering routine diagnostic imaging for acute low back pain. This is problematic because routine imaging does not seem to improve clinical outcomes and exposes patients to unnecessary harms. The overuse of imaging also contributes to the high and growing costs associated with low back pain. This article discusses evidence-based recommendations for the use of imaging tests in patients with low back pain, factors that promote the overuse of imaging, as well as how physicians can reduce overuse.
- The American College of Physicians (ACP) and the American Pain Society (APS) call for imaging only for patients with low back pain who have severe or progressive neurologic deficits – or signs or symptoms that suggest a serious or specific underlying condition.
- Patient expectations and preferences about diagnostic testing can affect clinical decisions, e.g., wanting diagnostic testing is a frequent reason for repeated office visits for chronic back pain.
- The number of MRI scanners in the U.S. tripled from 2000 to 2005, and in 2006 there were nearly as many MRI machines in western Pennsylvania as in all of Canada. Studies suggest that greater availability of imaging resources correlates with their increased use.
- To be most effective, efforts to reduce the use of diagnostic imaging should be multi-focal and should address clinician behaviors, patient expectations, and financial incentives.
- The authors suggest that implementation of the ACP/APS recommendations on judicious and selective low back imaging would improve patient care while reducing costs.
Dr. Owens is part of HSR&D’s Center for Health Care Evaluation in Palo Alto, CA; Dr. Shekelle is part of the VA Greater Los Angeles Healthcare System.
Chou R, Qaseem A, Owens DK, and Shekelle P. Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care from the American College of Physicians. Annals of Internal Medicine February 1, 2011;154(3):181-189.