Back Pain and Testing: Getting the Whole Picture

Back pain imaging tests conducted early not tied to better outcomes in older patients

(RxWiki News) Tests that let doctors look for clues inside the body may help solve medical conditions that cause back pain and other symptoms. However, balancing risks, benefits and costs for each procedure is the key to getting the best medical care.

A recent study found that older patients who had spine imaging shortly after primary care visits for back pain did not have less pain or disability over the following year than those who did not have such tests.

Jeffrey G. Jarvik, MD, of the University of Washington in Seattle, and colleagues studied data for more than 5,200 patients aged 65 or older who saw their primary care doctor for lower back pain between 2011 and 2013. About 1,500 of those patients had radiology tests like radiographs, magnetic resonance imaging (MRI) or computed tomography (CT) within six weeks of the visit.

X-ray tests like radiographs help doctors diagnose medical conditions and reduce unnecessary procedures. MRI is a technique that uses a magnetic field and radio waves to create detailed images of organs and tissues. CT scans use special X-ray equipment to create detailed pictures of areas inside the body.

At a 12-month checkup, patients who had early radiology tests said they had similar back pain to patients who did not have early tests, Dr. Jarvik and team said.

Some guidelines call for early testing for older patients, who are more likely to have serious underlying health problems. However, there is no proof that such tests help older patients, Dr. Jarvik and team noted.

"Our study demonstrates that older adults who had spine imaging within 6 weeks of a new primary care visit for back pain had pain and disability over the following year that was not different from matched patients who did not undergo early imaging," Dr. Jarvik and colleagues wrote.

Early radiology tests for older patients did not necessarily lead to needless or harmful procedures. However, patients who had early imaging spent more on health care than those who did not, Dr. Jarvik and team found. Insurance and out-of-pocket costs were around $1,400 higher per year for patients with early imaging.

"Our study results support an alternative position that regardless of age, early imaging should not be performed routinely," Dr. Jarvik and team wrote.

This study was published March 17 in JAMA.

Dr. Jarvik and team received royalties, grants and consulting fees from PhysioSonics, HealthHelp, the Informed Medical Decisions Foundation, UpToDate, Kaiser Permanente and Johnson & Johnson. The Agency for Healthcare Research and Quality and the NIH Intramural Research Program funded this research.

Review Date: 
March 17, 2015