Navigation Links
Routine scans for low-back pain do not improve outcomes
Date:2/6/2009

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 immediate imaging and usual clinical care. The authors say that the results are 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.

The authors report that lumbar imaging for low-back pain without indications of serious underlying conditions does not improve clinical outcomes. Therefore, clinicians should refrain from routine, immediate lumbar imaging in patients with acute or subacute low-back pain and without features suggesting a serious underlying condition.

They added: "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."

Patient expectations and preferences about imaging should also be addressed, because 80 percent of patients with low-back pain in one trial would undergo radiography if given the choice, despite no benefits with routine imaging, the reporters report. They indicated educational interventions for reducing the proportion of patients with low-back pain who believe that routine imaging should be done.

Other investigators who participated in this study include: Rick Deyo, M.D., M.P.H., Kaiser Permanente Professor of Evidence-Based Family Medicine, OHSU School of Medicine, Oregon Evidence-Based Practice Center; and Rochelle Fu, Ph.D., assistant professor of public health and preventive medicine, OHSU School of Medicine.

In an accompanying comment, Michael M. Kochen, Department of General Practice, University of Gttingen, Germany, and colleagues discuss how certain factors could hamper doctors changing practice to avoid immediate imaging, "such as patients' expectations about diagnostic testing, reimbursement structures providing financial incentives, or the fear of missing relevant pathology." They conclude: "Meanwhile a promising approach seems to be the way of educating patients in and outside general practitioners surgeries."


'/>"/>

Contact: Tamara Hargens-Bradley
hargenst@ohsu.edu
503-494-8231
Oregon Health & Science University
Source:Eurekalert

Related medicine news :

1. K-State Veterinary Lab Routinely Tests For Bluetongue Virus; Lab Director Says Strains Found in Kansas, U.S. Usually Less-Virulent
2. VivaScope(R) Confocal Imager May Eliminate Need for Routine Skin Biopsies for Dermatology Patients
3. Early, routine testing for HIV is key to curbing the disease among teens
4. JAMA Reports HIV Spike Among Gay Men; AHF Says Routine Testing, Effective Prevention Needed
5. Studies find stable sleep patterns and regular routines may improve outcomes in bipolar disorder
6. Maintaining Routine Can Chase Holiday Blues Away
7. ACPM concludes insufficient evidence to recommend routine prostate cancer screening
8. Routine screenings uncover hidden carbon monoxide poisoning
9. Step Up Your Smile Routine and Protect Your Teeth in Just Five Minutes a Day
10. Routinely used diagnostic approaches: only limited diagnostic sensitivity for bile duct cancer?
11. Wired, Working Americans Let Nighttime Health Routines Slide
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:5/26/2017)... (PRWEB) , ... May 26, 2017 , ... Mediaplanet is ... Wound Care" campaign in USA Today, which will educate readers on how to take ... the campaign, a large focus is placed on melanoma. Dancing with the Stars professional, ...
(Date:5/26/2017)... Clara, Calif. (PRWEB) , ... May 26, 2017 ... ... announces the integration of the CareFusion NOX-T3 portable sleep monitor with its Somnoware ... provides a consistent, browser-based interface for diagnostic device operations. With this platform, initializing ...
(Date:5/26/2017)... , ... May 26, 2017 , ... After raising nearly ... Top gadget will continue to be available at a discounted crowdfunding price on ... stress wherever they are, I also wanted to bring a fidget toy to the ...
(Date:5/26/2017)... , ... May 26, 2017 , ... “When the Stars ... Home” is the creation of published author Laura Weigel Douglas, an avid reader who ... in a house that sometimes feels like Green Hills Adventure Camp. She couldn’t be ...
(Date:5/26/2017)... ... , ... Water damage to the flooring of several classrooms at The Fort ... with a number of critical issues to address before students could return to classes. ... little or no disruption to class schedules. Second, the project had to comply with ...
Breaking Medicine News(10 mins):
(Date:5/11/2017)... 11, 2017  Thornhill Research Inc. ( ... an $8,049,024 USD five-year, firm-fixed-priced, indefinite-quantity/indefinite-delivery contract by ... Commercial Corporation (CCC) ( Ottawa, Ontario, Canada ... administer general anesthesia to patients requiring emergency medical ... US Marine Corps have been a longtime partner ...
(Date:5/10/2017)... , May 10, 2017 Radiology has become ... its costs have also spiraled to the number one ... to radiology than ever before as the most complete ... a patient with lower back pain an MRI may ... reason for pain, resulting in entirely different treatment protocols.  ...
(Date:5/9/2017)... , May 9, 2017  Oramed Pharmaceuticals Inc. ... a clinical-stage pharmaceutical company focused on the development ... the Canadian Intellectual Property Office has granted Oramed ... Administration of Exenatide". The patent covers Oramed,s invention ... GLP-1 is an incretin hormone that stimulates ...
Breaking Medicine Technology: