Tests for Most Low-Back Pain Are Worthless
“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,” explained Roger Chou, M.D., lead author and scientific director of the Oregon Evidence-Based Practice Center at OHSU, in a statement to media. “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.”
For their study, Dr. Chou and his research team conducted a meta-analysis of randomized controlled trials that compared immediate back imaging with CTs, MRIs or X-rays to regular care without any immediate imaging. In all, the OSHU researchers looked at six trials involving more than 1,800 patients to find out what outcomes they had, such as their degree of pain and function, quality of life, mental health, overall patient-reported improvement, and patient satisfaction.
The results? The investigators found no significant differences between people who had been sent for immediate imaging and those who had received standard clinical care without imaging. The only exception was in those patients who exhibited features of a serious underlying condition that are obvious to the physician during an exam.
In the press statement, the OSHU scientists said doctors treating patients with acute or subacute low-back pain and without features suggesting a serious underlying condition should refrain from routine, immediate lumbar imaging. “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,” they said.
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