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Most X-Rays, Scans Unnecessary for Acute Low Back Pain
Date:1/31/2011

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Despite this increase in spending, the ACP cite data from six different studies that found that people with spine problems who got radiological tests had similar or worse scores on quality of life and physical functioning assessments a year later, compared to patients who went without the scans.

One of the reasons that the increased spending may not be improving outcomes is that most people with back pain will get better on their own -- no matter what tests or interventions are done, the ACP experts said. In fact, they say, most people with acute back pain will begin to feel better within a month.

Overall, the results of X-rays, CT scans and the like rarely affect treatment plans, says the ACP, and if an abnormality is found on an imaging test, it can be difficult to know if that's the cause of the symptoms or if it was always there.

For example, in one study of people over 60 who did not have any back pain, the ACP reports that 90 percent had either spinal disc degeneration or a bulging disc in their back, and another 21 percent had narrowing in their spinal canal.

"Essentially, using routine imaging is not benefiting patients and it may even be harmful, because it can lead to further unnecessary additional tests, perhaps invasive procedures and increased radiation," said Qaseem.

So, what drives doctors to order these tests? Qaseem said there are a number of reasons. One is that physicians may feel that a patient expects a diagnostic test. Another is "defensive medicine," when a doctor orders a test to be sure he or she hasn't somehow missed an unusual condition. The wider availability of scanning technology may play a role, as may certain financial incentives, he said.

Dr. Anders Cohen, chief of neurosurgery and spine surgery at The Brooklyn Hospital Center in New York City, agreed that patient expectations and a concern about malpractice are significant contributors to the overuse of imaging for back pain.<
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