Less imaging for back pain

A new educational topic on low back pain from NPS MedicineWise could reframe the role of imaging in diagnosing non-specific low back pain, providing practice tips on how to manage consumer beliefs and expectations.

NPS MedicineWise medical adviser Dr Jeannie Yoo says low back pain is a common problem and the vast majority of acute cases are non-specific and self-limiting, resolving within four to six weeks.

“Low back pain is now the leading cause of disability worldwide and one in seven Australians suffer from back pain on any day,” Dr Yoo said.

“Early diagnostic imaging of the back is not recommended unless there’s a clinical suspicion of a serious spinal pathology, which accounts for less than one per cent of all low back pain.

“Imaging is commonly requested to aid in diagnosis and guide treatment strategies. However, acute non-specific low back pain is essentially a clinical diagnosis and, for patients with this condition, imaging doesn’t change management.

“Although patients may request imaging, they may not be aware of the harms that can result, such as anxiety from incidental findings and a greater risk of further investigations and inappropriate surgery, along with radiation exposure.”

Dr Yoo says in cases of low back pain, patient education, reassurance and staying active are first-line treatments for patients with non-specific pain.

“Patients need to be reassured that experiencing back pain does not mean ongoing harm to the spine, but staying active and maintaining normal movement are important elements of recovery,” she said.

The program will remind health professionals about diagnosis of non-specific low back pain, and alerting features for potential serious spinal pathologies that could require further investigation. It will also focus on how GPs can identify patients at increased risk of poor outcomes and educate on the importance of activity in recovery from low back pain.

The educational program corresponds with recent Choosing Wisely recommendations on low back pain by the Australasian Faculty of Occupational and Environmental Medicine; the Royal Australasian College of Physicians; the Australasian Faculty of Rehabilitation Medicine; the Australian Physiotherapy Association; and the Royal Australian College of Radiologists.

The program includes:

  • Free one-on-one educational visits for GPs.
  • A case study for GPs and practice nurses.
  • MedicineWise news article.
  • A podcast and other information for health professionals.
  • A patient action plan and consumer factsheet.

To access these resources and find out more, go to www.nps.org.au/lowbackpain