December 2018
Choosing Wisely® for Imaging Tests and Lower Back Pain
A current initiative of the American Board of Internal Medicine (ABIM) finds that improved communication in health care may be the key to improved use of imaging for lower back pain. Choosing Wisely is an ABIM program in partnership with Consumer Reports designed to help foster appropriate and cost-effective use of health care resources by conveying to physicians and their patients key insights from 50 clinical specialty groups.
According to the National Institutes of Health, in a three-month period about 25 percent of adults will experience at least one day of back pain.1 In some instances back pain can be severe, and imaging tests (MRI, CT and/or conventional X-rays) are often performed in an attempt to identify the source of the pain. However, medical specialty groups, including the American Academy of Family Physicians and the American Society of Anesthesiologists – Pain Medicine, recommend not performing imaging tests for low back pain for at least six weeks, unless red flags, such as history of cancer with potential metastases, known aortic aneurysm, progressive neurologic deficit, unexplained fever, weight loss or night pain are present.2,3 There are several reasons for the recommendation.
According to The Lancet medical journal, imaging tests when performed in the absence of red flags fail to correlate with improved outcomes.4 Moreover, the U.S. National Library of Medicine and The New England Journal of Medicine find that many older adults without symptoms have baseline abnormalities on imaging tests and many findings on imaging tests are inconsistent with patient symptoms leading to unnecessary surgery.5
For more information on low back pain, visit the Choosing Wisely website.
1National Institute of Arthritis and Musculoskeletal and Skin Diseases, What is back pain? Aug. 30, 2016. http://www.niams.nih.gov/Health_Info/Back_Pain/default.asp#2
2Crownover MD, Brian K. & Bepko MD, Jennifer L. (2013). Appropriate and Safe Use of Diagnostic Imaging. Am Fam Physician, 87(7). Retrieved from http://www.aafp.org/afp/2013/0401/p494.html
3American Society of Anesthesiologists, Patients suffering from chronic pain should question certain tests and treatments, Jan. 21, 2014. http://www.asahq.org/about-asa/newsroom/news-releases/2014/01/choosing-wisely-2
4The Lancet, Imaging strategies for low-back pain: systematic review and meta-analysis, Feb. 7, 2009. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60172-0/abstract
5The New England Journal of Medicine, Magnetic Resonance Imaging in Follow-up Assessment of Sciatica, March 14, 2013. http://www.nejm.org/doi/full/10.1056/NEJMoa1209250
Choosing Wisely is an initiative sponsored by the American Board of Internal Medicine Foundation that is solely responsible for the program and its content. The material presented here is for informational purposes only and is not intended to be medical advice, and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. Blue Cross and Blue Shield of Illinois (BCBSIL) makes no representations or warranties regarding the Choosing Wisely program or any of its components.