Routine Low-back Pain Scans Do Not Improve Outcomes

Evidence from a meta-analysis, published in The Lancet this month, has researchers from the Oregon Evidence-Based Practice Center at Oregon Health & Science University (OHSU) recommending that physicians “should not immediately order routine scans for low-back pain unless they observe features of a serious underlying condition,” as routine scans may not result in improved outcomes. In some cases, these scans even resulted in worse outcomes in pain, function, and anxiety level.

Lead author Roger Chou, MD, scientific director of the Oregon Evidence-Based Practice Center at OHSU, and colleagues reviewed six randomized controlled trials that together covered more than 1,800 patients. The trials compared CT, MRI, and X-ray scans with normal clinical care that did not involve immediate imaging. The trials reported a “range of outcomes including pain, function, quality of life, mental health, overall patient-reported improvement, and patient satisfaction.” No significant differences were found between t imaging and usual clinical care, with the data applying primarily to acute or sub-acute low-back pain.

Chou said that “Clinicians may think they are helping patients by doing routine X-rays or MRIs, but these diagnostic tests increase medical costs, can result in unnecessary surgeries or other invasive procedures, and may cause patients to stop being active probably the best thing for back health because they are worried about common findings such as degenerated discs or arthritis, not understanding that these are very weakly associated with back pain.”

The researchers also noted that the expectations and preferences of patients about imaging should be addressed, because “80 percent of patients with low-back pain in one trial would undergo radiography if given the choice, despite no benefits with routine imaging…[indicating that] educational interventions for reducing the proportion of patients with low-back pain who believe that routine imaging should be done.”

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specialty: pain management