AIM: New recommendations target low back pain imaging

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The American College of Physicians (ACP) has concluded that routine imaging for low back pain does not improve patient health and contributes to wasteful and potentially harmful procedures. The revised recommendations were published Feb. 1 in the Annals of Internal Medicine.

“Low back pain is one of the most common reasons for a patient to see a physician and many patients with low back pain receive routine imaging that is not beneficial and may even be harmful,” said Amir Qaseem, MD, PhD, MHA, FACP, director of clinical policy for ACP.

Following a systematic review and meta-analysis conducted for the Diagnosis and Treatment of Low Back Pain joint ACP and American Pain Society guidelines, ACP recommended low back imaging such as x-ray, CT and MRI only for selected higher-risk patients with severe or progressive neurologic deficits, suspected serious or specific underlying conditions or in candidates for invasive interventions.

ACP’s recommendations were part of its “Advice for High-Value Health Care” series of papers, which aim, in part, at cutting unnecessary imaging and wasteful healthcare spending.

“The best way to maintain effective and efficient care is to identify and eliminate wasteful practices, and to demonstrate which interventions provide high-value, which means their benefit is sufficient to justify their harms and costs,” argued Paul Shekelle, MD, PhD, FACP, chair of ACP's Clinical Guidelines Committee.

ACP’s Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care also states:

  • Decisions for repeat imaging should be based on the development of new symptoms or changes in current symptoms.
  • To be most effective, efforts to reduce routine imaging should take into account clinician behaviors, patient expectations and financial incentives.
  • Patient education strategies should be utilized to inform patients about current and effective standards of care and help them understand the benefits and harms of the radiological testing.