A new literature and financial analysis, published online June 4 in Archives of Internal Medicine, supports the National Physicians Alliance's recommendation against routine imaging in patients with acute low back pain, says an article by Medscape Medical News.
The recommendation to avoid early imaging for low back pain within the first 6 weeks of onset unless red flags are present was published August 8, 2011, as part of the alliance's list of Top 5 Health Care Activities for Which Less Is More. The Less Is More series is focused on areas that responsible physician stewardship can help improve the quality and reduce the potential harms of care.
In the current literature review, the authors report that imaging for low back pain is extremely common and does not improve clinical outcomes in patients without indications of serious underlying conditions. Furthermore, they estimate that "nearly $300 million could be saved annually by restricting imaging during the first 6 weeks of lumbar back pain to specific severe indications, including severe or progressive neurological deficits or when serious underlying conditions, such as osteomyelitis, are suspected," Medscape says.
Reasons why physicians may continue to order imaging for acute low back pain include legal concerns, patient preferences, time pressures that might make it easier to order an imaging procedure than to discuss the condition, and financial incentives, say the authors.