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Enhancing Management of Lower Back Pain

Enhancing Management of Lower Back Pain

About 25% of adults report having low back pain lasting at least 1 whole day in the preceding 3 months. Imaging for acute low back pain is common, with a reported 42% of patients receiving imaging within 1 year, mostly plain radiography. Studies, however, indicate that lumbar imaging for low back pain without indications of serious underlying conditions does not improve clinical outcomes. More than 85% of patients seen in primary care have low back pain that cannot be attributed to specific disease or anatomic abnormalities. Refrain From Low Back Imaging Within First 6 Weeks In 2012, the National Physicians Alliance launched the initiative “Promoting Good Stewardship in Clinical Practice,” in which a list of the top five activities for primary care was developed to foster higher-quality care and better use of finite clinical resources. One of the top recommendations was to not perform imaging for low back pain within the first 6 weeks unless red flags are present. In the Archives of Internal Medicine, my colleagues and I had a study published in which we selectively researched benefits and risks of routine imaging in low back pain.             The available studies suggest that there is no clinically significant difference in low back pain or function between those who receive immediate lumbar spine imaging and those receiving usual care. Published data also document harms associated with early imaging for low back pain, including patient labeling, unneeded follow-up tests for incidental findings, radiation exposure, unnecessary surgery, and significant cost. By not routinely imaging patients with acute low back pain, there is potential to reduce harms...
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