Why Your Doctor Doesn’t Want to X-Ray Your Back

Low Back Pain X-Ray

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It was big news recently when the National Physicians Alliance (NPA) issued recommendations to primary care clinicians to limit certain screening and diagnostic procedures that don’t contribute to patient care–and may even impede it. At the top of the list: a recommendation not to order imaging studies for low back pain within the first six weeks of the onset of pain, except when the clinical setting or the neurologic exam raises concern for serious underlying pathology. In other words, if a health care provider doesn’t detect anything abnormal about a patient’s low back pain–which is extremely common–then, according to this new recommendation, he or she should simply send the patient home without ordering any further imaging tests. That means no X-rays, no CAT scans, and no MRIs.

Imaging Studies Don’t Improve Patient Outcomes, May Be Harmful

On June 4th, 2012, the Archives of Internal Medicine published an examination of all the studies on the benefits and risks of routine imaging in low back pain that were completed in the past five years. In the article, the researchers presented data that supported the recommendation; they concluded that there was no clinical difference in the pain or outcome experienced by patients who received imaging studies within six weeks of the onset of pain and those who didn’t. Furthermore, the investigators noted the potential for serious harm: The patients who received imaging studies experienced needless anxiety, which no doubt contributed to increased pain scores and an overall sense of poor health. Even more importantly, patients who had imaging studies were dramatically more likely to undergo surgery, which–since the long-term outcomes were the same in both patient groups who underwent screening and those who didn’t–in most cases was probably not needed.

So if you have low back pain and your doctor doesn’t immediately order a battery of radiologic procedures, be grateful that he or she is doing the right thing. You almost certainly don’t need any further testing, and stand to lose a great deal if you succumb to the mistaken notion that more testing necessarily means better medicine.

Editor’s Note: Experiencing low back pain? Be sure to check out these three articles for gentle stretches and back care tips. 

Stretch Your Front to Ease Your Back
Stretch Yourself: Yoga for Back Pain
Got 5 Minutes? Ease Your Back with a Simple Stretch


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The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, the San Francisco Bay Area, Seattle, and Washington, DC.

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