Routine scans dont improve outcomes for low-back pain patients

February 7th, 2009 - 12:36 pm ICT by ANI  

London, February 7 (ANI): Researchers at Oregon Health and Science University are recommending doctors not to immediately order routine scans for patients with low-back pain unless a significant underlying condition is first identified.
In their study report, published in the journal The Lancet, the researchers have revealed that the regular use of radiography, MRI or CT scans in patients with low-back pain, but no indication of a significant underlying condition, does not improve their outcome.
“Our study shows that performing routine X-rays or MRIs for patients with low-back pain does not lead to improved pain, function or anxiety level, and there were even some trends toward worse outcomes,” said lead author Dr. Roger Chou.
“Clinicians may think they are helping patients by doing routine X-rays or MRIs, but these diagnostic tests increase medical costs, can result in unnecessary surgeries or other invasive procedures, and may cause patients to stop being active probably the best thing for back health because they are worried about common findings such as degenerated discs or arthritis, not understanding that these are very weakly associated with back pain,” he added.
Chou revealed that he and his colleagues carried out a meta-analysis of randomised controlled trials that compared immediate back imaging using one of the three scanning types above with usual clinical care that does not involve immediate imaging.
He said that the research team included six trials covering more than 1,800 patients, which had reported a range of outcomesincluding pain and function, quality of life, mental health, overall patient-reported improvement, and patient satisfaction.
The researcher said that his teams analysis showed that there were no significant differences between immediate imaging and usual clinical care.
According to him, the results were most applicable to acute or sub-acute low-back pain of the type assessed in a primary care setting with the patient’’s family doctor.
Following his teams observations, Chou said that lumbar imaging for low-back pain without indications of serious underlying conditions would not improve clinical outcomes, and thus doctors should refrain from routine and immediate imaging in patients with acute or subacute low-back pain without identifying a serious underlying condition.
“Rates of utilization of lumbar MRI are increasing, and implementation of diagnostic-imaging guidelines for low-back pain remains a challenge. 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,” the authors said.
The researchers also observed that 80 percent of the patients with low-back pain in one trial would undergo radiography if given the choice, despite no benefits with routine imaging.
They suggested that educational interventions could help reduce the proportion of those patients with low-back pain who believe that routine imaging should be done.
They conclude: “Meanwhile a promising approach seems to be the way of educating patients in and outside general practitioners surgeries.” (ANI)

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