Physicians should not immediately order routine scans for low-back pain unless they observe features of a serious underlying condition, researchers in the Oregon Evidence-Based Practice Center at Oregon Health & Science University report. Their findings are published in this week's edition of the The Lancet.
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, the researchers report.
"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 Roger Chou, M.D., lead author; scientific director of the Oregon Evidence-Based Practice Center at OHSU; and associate professor of medical informatics and clinical epidemiology, and medicine (general internal medicine and geriatrics) in the OHSU School of Medicine.
"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."
To reach this conclusion, Chou and colleagues conducted a meta-analysis of randomized 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. Six trials covering more than 1,800 patients were included, reporting a range of outcomes including pain and function, quality of life, mental health, overall patient-reported improvement, and patient satisfaction.
The analysis found no significant differences between i
|Contact: Tamara Hargens-Bradley|
Oregon Health & Science University