Is Imaging Always Appropriate in Evaluating Back Pain?

Mary Franz - Mar 25th, 2011

X-rays are a common imaging technique used for any number of medical evaluations, including low back pain. Techniques that are less common, but still used in evaluating low back pain include magnetic resonance imaging (MRI) as well as various imaging devices such as computed tomography. All of these come with a cost, and recent clinical guidelines indicate they may not be necessary in many cases of back pain.

The American College of Physicians has set forth new clinical guidelines for using imaging devices after evaluating their cost and efficacy in forming proper treatment plans for low back pain. The guidelines were developed after several findings including the increased cost and use of imaging over the last several years with no improvement and in fact, worsened statistics on those suffering with back pain and how it affects various aspects of their lives such as productivity and overall quality.

Within the guidelines, imaging is recommended if the back pain is new and the patient has a history of cancer, strong evidence of cancer or multiple risk factors for cancer. Other reasons are high suspicion of the back pain being secondary to infection, cauda equine syndrome, or in the presence of neurological defects such as motor weakness.

In some cases, the guidelines suggest imaging be deferred until a one-month trial of therapy is completed with little or no improvement. It was recommended that no imaging should be used in cases where the patient has had significant improvement after treatment.

Lowering the costs of healthcare is and should be a goal in the United States and elsewhere. Chiropractic care has been proven time and time again to be an effective low-cost alternative treatment for back pain.

Chou R, Qaseem A, Owns D, Shekelle P. Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care From the American College of Physicians. Annals of Internal Medicine 2011; 154;181-189.