Question All Those Lower Back Pain Tests

Chances are many of us spent a recent night propped up with a heating pad on our lower backs.

Experts estimate that as much as 80 percent of the population will experience back problems at some point in their lives.

Many doctors order CT and MRI scans out of fear the patients will be upset if they don’t get imaging.

Lower back pain is the leading cause of disability worldwide and the second most common reason for visits to the doctor’s office. Back pain in general is one of the most common reasons for missed work.

Here’s the deal, though — the tests our doctors are ordering aren’t really working.

The American Board of Internal Medicine (ABIM) launched a campaign in 2013 called Choosing Wisely — with a goal of advancing a national dialogue on avoiding wasteful or unnecessary medical tests, treatments, and procedures. ABIM recommends against imaging scans for low back pain unless there are specific “red flags.” These include unexplained weight loss, a fever over 102° F, loss of control of the bowel or bladder, a loss of strength in the legs, problems with reflexes, or a history of cancer.

Three years later, however, a new study finds that many doctors are still ordering CT and MRI scans for patients with low back pain, mainly out of fear that patients will be upset if they don’t get imaging. There is also far too little time explaining the risks and benefits of the tests, the ABIM stated.

Related: Get Up Out Of Your Chair, Please

Another study earlier this year found that almost a third of lumbosacral magnetic resonance imaging (MRI) scans at the Department of Veterans Affairs (VA) were “inappropriate,” the authors noted.

Preventing Back Pain
  • Maintain a healthy diet and weight.
  • Remain active.
  • Avoid prolonged inactivity or bed rest.
  • Warm up or stretch before exercising or engaging in physical activities.
  • Maintain proper posture.
  • Wear comfortable, low-heeled shoes.

“Overuse of diagnostic tests is a common problem in health care as a whole, and affects both the VA and private-sector settings,” said co-author Dr. Erika D. Sears of the Veterans Affairs Center for Clinical Management Research in Ann Arbor, Michigan, as Reuters reported. “Low back pain is often highlighted because it is a common condition where overuse of imaging or treatments can consume a high level of resources.”

In the VA study, researchers asked 579 VA physicians, nurse practitioners, and physician assistants about a hypothetical scenario: They asked if a 45-year-old woman with nonspecific low back pain requested a computed tomography (CT) scan or MRI.

Only 3 percent of clinicians thought the tests would be beneficial, and more than 75 percent believed a scan would lead to more unnecessary tests or procedures. But just as many also felt they couldn’t make a referral to a specialist without obtaining imaging first — and more than half worried the woman would be upset if she didn’t get the imaging she wanted.

CT scans expose a patient to radiation, which can add up over time. Even without that, unnecessary tests can reveal unexpected findings that may be insignificant but lead to more testing — and sometimes complications.

“Patients should first have a thorough history and physical exam to rule out the presence of ‘red flag’ symptoms. They’re often first referred to physical therapy in the initial treatment period,” Sears said. “Because low-back pain tends to [return], staying active, through activities such as walking, yoga, and supervised training, is key to warding off recurrence.”

Most people will get over lower back pain in just a few weeks, the ABIM Foundation says on its website, especially if they follow these steps:

1.) Stay active. Walking eases lower back pain. Staying in bed makes you stiff, weak, and even depressed. Get up and move.

2.) Use heat. It relaxes the muscles. Try a heating pad, electric blanket, warm bath, or shower.

3.) Take over-the-counter medicines. To help relieve pain and reduce swelling, try these meds. Generic medicines cost less than brand names, but work just as well.

Related: That Backpack is Way Too Heavy

4.) Sleep on your side or on your back. Lie on your side with a pillow between your knees. Or lie on your back with one or more pillows under your knees.

5.) Talk to your doctor. If your pain is very bad, ask about prescription pain medicines. If they don't help within a few days, talk with your doctor again. Ask if the pain might be caused by a serious health problem.

6.) Find out about other ways to treat back pain. If you still have pain after a few weeks, talk with your doctor about other treatments. Physical therapy, chiropractic care, acupuncture, yoga, massage, and progressive muscle relaxation all can help.

Surgery, the ABIM states, should be your last choice. "Surgery usually does not help very much. It has risks, and it costs a lot. Consider having surgery only if other treatments do not help your pain."

Last Modified: October 18, 2016, 8:44 am

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