Skip the MRI for Low Back Pain?

New Guidelines Suggest Imaging Tests May Not Be Needed for All Patients—January 31, 2011

Immediate imaging with X-rays, CT scans, or MRIs for patients with acute low back pain is not recommended for all patients, according to new guidelines by the American College of Physicians.

The guidelines, which appear in the Feb. 1 issue of the Annals of Internal Medicine, suggest that such imaging tests are appropriate for people with low back pain that may be due to cancer, infection, nerve damage, or pain that worsens despite initial treatment.

Signs of these more serious conditions include weight loss, fever, loss of muscle strength, and/or sensation in the legs and abnormal reflexes in addition to the low back pain.

Persistent Back Pain
The new guidelines suggest further testing if the low back pain worsens or persists despite a trial of therapy.

Richard J. Herzog, M.D., an attending radiologist at Hospital for Special Surgery in New York City, says, “If pain persists, you would then do appropriate imaging studies to decide the appropriate therapies.”

“Yes, imaging is overutilized, but the more patients are educated, the more these tests will be ordered appropriately,” he says.

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