While back pain is one of the most common reasons for people to visit the doctor, a study published this week in The Lancet finds that imaging techniques such as X-rays that are commonly used for diagnosing back pain have no effect on the outcome for most patients. Even worse, some imaging techniques expose patients to low levels of radiation that may increase the risk of some cancers.

Researchers at the Oregon Health and Science University in Portland examined how more than 1,800 patients fared after visiting their family doctor with acute (severe but short-lived) or subacute (less severe but longer lasting) lower back pain. They found that patients who showed no sign of a serious underlying condition but whose doctors recommended lower back imaging by either X-ray, CT scan, or MRI showed no differences from those who did not undergo such imaging procedures on a wide variety of clinical outcomes including pain and functioning, quality of life, mental health, overall improvement and patient satisfaction.

X-rays and CT scans use radiation to create an image of the lower back and so they expose patients to low to moderate amounts of ionizing radiation, a risk factor for several cancers. While MRIs do not use radiation, they are significantly more expensive than the other techniques.

The researchers say that despite the fact that most patients who visit the doctor for lower back pain do not have any serious underlying condition causing the pain, doctors often order immediate imaging procedures to check for problems like herniated disks, muscle injuries, arthritis or broken bones anyway. They urged doctors to be more judicious when deciding which patients should be sent for X-ray, CT, or MRI, and reserve such procedures for cases in which there is a concrete sign of a problem that imaging may be able to diagnose.

An accompanying editorial by researchers at the University of Gottingen in Germany lists several reasons why doctors may order imaging for their patients with lower back pain without any indication that such a procedure is medically necessary. For one, patients often expect their doctors to order some kind of diagnostic test and may feel slighted if they do not. In fact, a recent study showed that 80 percent of people with low back pain said that, if given the choice, they would have imaging even without expected benefits. Additionally, fear of missing the rare case where a patient does have a serious medical problem that is not obvious on a physical exam and the structure of financial reimbursement incentives for doctors may also make it more likely for them to order such tests.

If you have low back pain and you visit the doctor, ask them if imaging is appropriate in your case. If the doctor identifies something in the physical exam that warrants such testing, then it is very likely worth the cost and/or radiation exposure to undergo the procedure. However, if the doctor does not have any concrete sign that imaging is warranted, or if he or she leaves it up to you, you may want to consider carefully whether imaging is really necessary. Keep in mind that most back pain improves within a few weeks with over-the-counter pain relievers and self-care.

For more information about lower back pain, see the Healia Health Guide on Back Pain. To share your story about back pain and find out what others have to say, join the Healia Health Community for Back Pain.

_{Photo: gogogadgetscott, Flickr, Creative Commons}