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Imaging for mechanical back pain

Back pain is a common ailment affecting millions of individuals worldwide, leading to substantial healthcare expenditures and lost productivity. When patients present with back pain, healthcare providers may resort to imaging studies, such as X-rays, CT scans, and MRIs, to aid in diagnosis and treatment planning. However, there is mounting evidence suggesting that patients are frequently subjected to unnecessary and excessive imaging for back pain, leading to increased costs, potential harm, and minimal improvement in patient outcomes.

  • Less than 5-10% of all low back pain is due to a specific underlying spinal pathology

  • The remaining 90-95% has no indication of a serious cause and should be managed with conservative treatments such as advice and reassurance, exercise, physical therapy, cognitive-behavioural therapy, or pain management

  • Diagnostic triage based on clinical history and examination can help distinguish between non-specific or more serious low back pain

  • Imaging may do more harm than good when serious conditions are not suspected and is likely to prolong recovery in patients with non-specific low back pain

  • Patients’ primary concerns of whether their pain is caused by something serious and what they should do to aid recovery can be addressed by sound education and reassurance, without the need for imaging

The over-imaging of patients with back pain has emerged as a pervasive issue in healthcare, leading to increased costs, potential harm, and minimal improvement in patient outcomes. The evidence overwhelmingly supports the notion that imaging should be reserved for specific red flags and complex cases, while conservative management strategies should form the cornerstone of initial back pain management. By implementing guidelines, promoting shared decision-making, and focusing on patient education, healthcare providers can contribute to mitigating the over-imaging epidemic, ensuring optimal care for patients with back pain while reducing unnecessary healthcare expenditures.


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