Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care From the American College of Physicians

@article{Chou2011DiagnosticIF,
  title={Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care From the American College of Physicians},
  author={Roger Chou and Amir Qaseem and Douglas K. Owens and Paul Shekelle},
  journal={Annals of Internal Medicine},
  year={2011},
  volume={154},
  pages={181 - 189}
}
Diagnostic imaging is indicated for patients with low back pain only if they have severe progressive neurologic deficits or signs or symptoms that suggest a serious or specific underlying condition. In other patients, evidence indicates that routine imaging is not associated with clinically meaningful benefits but can lead to harms. Addressing inefficiencies in diagnostic testing could minimize potential harms to patients and have a large effect on use of resources by reducing both direct and… 
Repeated Imaging for Diagnosis of Low Back Pain
Diagnostic imaging is indicated for patients with low back pain only if they have severe progressive neurologic deficits or signs or symptoms that suggest a serious or specific underlying condition.
Do not routinely offer imaging for uncomplicated low back pain
TLDR
Patients’ primary concerns of whether their pain is caused by something serious and what they should do to aid recovery can be addressed by sound education and reassurance, without the need for imaging.
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TLDR
Current trends and practice patterns in lumbar spine imaging, direct and downstream costs, benefits and harms, current recommendations, and potential strategies for reducing imaging overuse are reviewed.
Appropriate use of diagnostic imaging in low back pain: a reminder that unnecessary imaging may do as much harm as good.
TLDR
An outline of the appropriate use, as defined in recent guidelines, of diagnostic imaging in patients with low back pain is described and an example of a successful clinical pathway that has reduced imaging and improved outcomes is presented.
Low Back Pain
TLDR
Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific LBP and should evaluate patients with persistent LBP with MRI (preferred) or CT only if they are potential candidates for surgery or epidural steroid injection (for suspected radiculopathy).
Low back pain
2. Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern
Low-back pain
TLDR
Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific LBP and should evaluate patients with persistent LBP with MRI (preferred) or CT only if they are potential candidates for surgery or epidural steroid injection (for suspected radiculopathy).
An evidence-based approach to the evaluation and treatment of low back pain in the emergency department.
  • P. Borczuk
  • Medicine
    Emergency medicine practice
  • 2013
TLDR
This review explores an evidence-based rationale for the evaluation of the patient with low back pain, and it provides guidance on risk stratification pertaining to laboratory assessment and radiologic imaging in the emergency department.
Evaluation and Treatment of Low Back Pain in Adult Patients.
TLDR
Most patients with acute/subacute low back pain will resolve regardless of the modality used or not used, but recognizing red flags early in the evaluation is crucial to expedite appropriate treatment.
ACR Appropriateness Criteria Low Back Pain.
TLDR
Imaging is considered in patients who have had up to 6 weeks of medical management and physical therapy that resulted in little or no improvement in their back pain, and for patients presenting with red flags raising suspicion for serious underlying conditions, such as cauda equina syndrome.
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References

SHOWING 1-10 OF 92 REFERENCES
Magnetic resonance imaging and low back pain care for Medicare patients.
TLDR
It is found that increases in MRI supply are related to higher use of both low back MRI and surgery, and this is worrisome, and careful attention should be paid to assessing the outcomes for patients.
Imaging strategies for low-back pain: systematic review and meta-analysis
TLDR
Clinicians should refrain from routine, immediate lumbar imaging in patients with acute or subacute low-back pain and without features suggesting a serious underlying condition, as results are most applicable to acute orSubacuteLow-Back pain assessed in primary-care settings.
Physician variation in diagnostic testing for low back pain. Who you see is what you get.
TLDR
There is little consensus, either within or among specialties, on the use of diagnostic tests for patients with back pain, and the diagnostic evaluation depends heavily on the individual physician and his or her specialty, and not just the patient's symptoms and findings.
Diagnostic Evaluation of Low Back Pain with Emphasis on Imaging
TLDR
Taking a history is more useful than physical examination in screening for underlying malignancy, at least in the early stages (Table 2) (7, 10).
Use of lumbar radiographs for the early diagnosis of low back pain. Proposed guidelines would increase utilization.
TLDR
The implementation of the AHCPR guidelines for the initial use of radiographs in patients with low back pain may increase utilization and economic costs and a more restricted and cost-efficient set of guidelines should be proposed.
Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society
TLDR
This guideline is to present the available evidence for evaluation and management of acute and chronic low back pain in primary care settings and grades its recommendations by using the ACP's clinical practice guidelines grading system.
Overtreating Chronic Back Pain: Time to Back Off?
TLDR
There is a need for a better understanding of the basic science of pain mechanisms, more rigorous and independent trials of many treatments, a stronger regulatory stance toward approval and post-marketing surveillance of new drugs and devices for chronic pain, and a chronic disease model for managing chronic back pain.
Rapidity and modality of imaging for acute low back pain in elderly patients.
TLDR
Rapidity and modality of imaging for LBP is associated with patient and physician characteristics but the directionality of associations with desirable care processes is opposite of associations for measures targeting underuse.
Prevalence of and screening for serious spinal pathology in patients presenting to primary care settings with acute low back pain.
TLDR
In patients presenting to a primary care provider with back pain, previously undiagnosed serious pathology is rare, indicating that, when used in isolation, red flags have little diagnostic value in the primary care setting.
Effects of Diagnostic Information, Per Se, on Patient Outcomes in Acute Radiculopathy and Low Back Pain
TLDR
Patient knowledge of imaging findings do not alter outcome and are associated with a lesser sense of well-being.
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