MRI & Low Back Pain
As we try to utilize medical dollars more efficiently, medical societies will providing more opinions and guidelines regarding diagnosis and treatment of illness. Recently, both the American Academy of Family Physicians and American College of Physicians published recommendations regarding imaging and low back pain. In general, imaging of the spine should be deferred for six weeks in patients with low back pain. Conservative therapy often consisting of physical therapy and anti-inflammatories is recommended during the initial pain episode. The exceptions include limb weakness, blow and bladder difficulties, persistant fever or other risk factors such as cancer. When treating patients with complaints of spinal pain, I carefully examine the patient and consider all underlying factors. At our Northshore clinic, we advocate for imaging studies when we believe it is appropriate for the patient. Below are summaries of statements from two medical societies:
Don’t do imaging for low back pain within the first six weeks, unless red flags are present.
The American Academy of Family Physicians points out that because imaging tests don’t improve outcomes in back pain and do increase costs, it’s unnecessary to order them within the first six weeks, unless there are red flags. These include the presence of significant or progressive neurological deficits or the suspicion of serious underlying conditions such as osteomyelitis.
Don’t obtain imaging studies in patients with non-specific low back pain.
The American College of Physicians (ACP) came out with this similar recommendation at the same time, echoing the caution that in patients with back pain that cannot be attributed to a specific disease or spinal abnormality following an appropriate history and physical examination, imaging studies do not improve outcomes.