Imaging for low back pain (LBP) is only recommended in certain situations. The Choosing Wisely campaign suggests avoiding imaging during the first six weeks in the absence of red flags, like weight loss, a history of cancer, recent trauma, osteoporosis or age greater than 50.
And imaging for LBP is overused. For example, a meta-analysis in press (https://bit.ly/2P5Ux8X) shows that 32% to 35% of low back pain imaging is inappropriate.
What are the main reasons? It's not that providers don't know what to do. A survey in 2014 (https://bit.ly/2BLCAus) showed the following factors were important:
- Inability to refer to a specialist without an image
- Worry that patient would be upset
- Not enough time to discuss risks/benefits with patient
- Concern about malpractice risk
Of these factors, the only ones influenceable by the ordering provider involve patient education. This can be problematic in a time-limited office visit. However, the Choosing Wisely campaign suggests these messages:
- The tests will not help you feel better faster. You're likely to feel better in about a month whether or not you get a test. The test can also lead to surgery and other treatments that you do not need.
- Imaging tests have risks. Radiation's harmful effects add up.
- Imaging tests are expensive. The cost is especially burdensome to you if you have a high-deductible plan.
Choosing Wisely has a great handout, also: https://bit.ly/2w3dvWJ
Keep in mind that frequently imaging is necessary, but not ordered. The meta-analysis cited above found that this occurred in 61% to 68% of cases where imaging was indicated, based on the presence of red flags.