Guidelines for Diagnosing Low Back Pain

Low back pain is one of the most common reasons for patients to see physicians. Many who suffer from low back pain receive routine imaging (performed without a clear clinical indication). Routine imaging, however, has not been shown in randomized trials to improve patient outcomes when compared with usual care without routine imaging. In addition, routine imaging can lead to unnecessary additional tests, interventions, follow-ups, and referrals. In some cases, imaging tests may even be harmful. Nonetheless, use of imaging tests, particularly MRI, for low back pain continues to increase.  To address this issue, the Clinical Guidelines Committee of the American College of Physicians (ACP) released recommendations for diagnostic imaging for low back pain. Published in the February 1, 2011Annals of Internal Medicine, these guidelines are the first in a series to help physicians and patients identify potentially misused medical treatments and to practice high-value healthcare. Important New Recommendations for Low Back Pain A key theme of the ACP guideline is that routine imaging for low back pain does not appear to improve patient health. This is based on evidence that the use of diagnostic imaging in patients without indications offers little or no benefit. The vast majority of imaging findings do not correlate well with the presence or severity of symptoms, and do not affect initial management. Randomized trials comparing routine imaging with usual care without imaging suggest there is no clinically meaningful benefit on outcomes of pain, function, quality of life, or mental health. The guideline recommends immediate imaging for patients with acute low back pain who have the following: Major risk factors for cancer (personal history...