ACP: Reserve Advanced Imaging of Lower Back Pain for Higher-Risk Patients

February 2, 2011
Sara Michael

In a new guideline, the American College of Physicians said there was strong evidence that routine X-ray, CT scan, or MRI for low back pain doesn’t improve patients’ health. Instead, those tests should be given only to patients with severe or progressive neurological deficits, who are suspected of having a serious or specific condition, or who are candidates for invasive interventions.

Advanced imaging for lower back pain should be reserved for higher-risk patients, according to the American College of Physicians.

In the new guideline, which is the first in a series of papers aimed at helping physicians identify misused medical treatments, ACP said there was strong evidence that routine X-ray, CT scan, or MRI for low back pain doesn’t improve patients’ health. Instead, those tests should be given only to patients with severe or progressive neurological deficits, who are suspected of having a serious or specific condition, or who are candidates for invasive interventions.

The recommendations, called “Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care from the American College of Physicians,” were published in the Feb. 1 issue of Annals of Internal Medicine:

“Unnecessary imaging can lead to a series of unnecessary additional tests, interventions, follow ups, and referrals that do not improve patient outcomes,” according to Amir Qaseem, MD, PhD, MHA, FACP, director of clinical policy for ACP.

ACP recognized that patients often expect imaging tests, and some physicians worry about being sued if they don’t order the tests.

Here’s what ACP recommends:

• Physicians should use a patient’s history and physical exam to determine whether the low back pain is musculoskeletal or caused by a serious condition.
• Doctors should not order an X-ray, CT scan, or MRI unless they suspect a serious cause of the pain.
• Decisions about repeated imaging should be based on new or changed symptoms.
• Doctors should develop education strategies to inform patients about effective standards of care.