X-rays Unnecessary for Low Back Pain, Usually

In treating low back pain, an education program by National Prescribing Service, in Australia, claims that in the absence of indicators of more serious problems, diagnostic imaging may not be necessary.

Low back pain is a common condition in Australia. The condition affects four in five Australians at some point in their lives. The pain can be debilitating and in about 85% of cases the cause is non-specific.

“Most cases of acute low back pain are not due to any serious injury, disease or damage to the spine and aren't associated with lasting damage,” NPS clinical adviser, Danielle Stowasser said, in a press release.

“People have come to expect a scan or x-ray to diagnose the problem, but they need to understand diagnostic imaging isn't usually necessary in acute non-specific low back pain. In most cases having a scan will not change the treatment options or recovery time.”

Scan and X-ray orders have increased significantly in Australia over the last decade. A review of General Practitioner activity using the BEACH dataset from 2008-09 showed nearly one in 10 consults led to imaging orders, generating an additional 2.7 million imaging orders than in 1999-2000. In 2008-09 5% of diagnostic imaging related to back pain.

“Needless imaging can unnecessarily expose people to doses of radiation,” Stowasser said. “Many people don't realize that a lumbar spine CT scan may deliver a dose of radiation equivalent to 165 chest x-rays.”

The NPS recommends the following approaches for managing acute non-specific low back pain:

- Reassure people it is common and that most people improve within a few days or weeks.

- Advise people that imaging tests are not recommended in routine evaluation of non-specific acute low back pain in the absence of features of a serious underlying condition.

- Consider non-medicine approaches including staying active and trying hot or cold packs for short-term relief

- If a medicine is needed to manage the pain and enable people to stay active, encourage use of simple analgesics. Regular paracetamol is the preferred choice of analgesic given it has fewer side effects than other pharmacological options, especially if used in the longer term. Reiterate the importance of using only the recommended dose and speaking to a doctor if effective regular pain relief is not being achieved with paracetamol alone.

- Advise people to stay active by starting slowly and gradually building up to their normal level of daily activity. Remind them to keep moving and not spend more than 20-30 minutes sitting or lying in one position during the day.

A range of resources have been developed for health professionals in educating patients about managing their lower back pain including:

- Managing your acute low back pain: symptomatic management pads

- Posters aimed at consumers to be put in surgeries, pharmacies and clinics

- Online videos and content for consumers here.

A consumer campaign about over-the-counter analgesics that includes managing acute lower back pain will be launched in February 2011.

Source: NPS

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Do you find that imaging tests are often overused in treating low back pain?