Tuesday, April 10, 2012

An Xray for Your Aching Back?

Last week, the “Choosing Wisely” campaign was unveiled to physicians and patients alike. The concept was for each major specialty to identify five interventions that traditionally, physicians have ordered (and patients have expected) yet now evidenced-based medicine is telling us that these are simply unnecessary, not truly beneficial, and/or costly in dollars or health. For the next week, I would like to add my two cents worth for each of the five interventions highlighted by my academy- the American Academy of Family Physicians.

The first recommendation is to AVOID IMAGING (x-rays, CT or MRI scans) for LOW BACK PAIN that has been present less than six weeks
Did you know that low back pain is the 5th most common reason that people head to their doctor? We “throw out” our backs at an amazing rate, and it’s usually just from bending over or vacuuming more than moving baby grand pianos. The vast majority of low back pain is muscular, and a combination of anti-inflammatory medications (like ibuprofen), topical modalities (heat & massage) and judicious use of muscle relaxants-plus TIME measured in days, not hours- will take care of the problem. Ergonomic evaluations and physical therapy can also do wonders for low back pain, especially if it is recurrent. Insisting on an x-ray or fancy scan will certainly reduce the thickness of your wallet, but is unlikely to reduce your pain.

BOTTOM LINE: Hold off on x-rays or other scans for low back pain unless your pain has persisted more than six weeks, or your doctor sees “red flags” that suggest less common, more serious underlying issues.

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