BACK PAIN: DOES EARLY IMAGING IMPROVE OUTCOMES?
Jarvik JG, Gold LS, Comstock BA, et al. Association of early imaging for back pain with clinical outcomes in older adults. JAMA. 2015;313(11):1143-1153.
Early imaging for back pain is not associated with better one-year outcomes among patients ages 65 and older, according to a prospective cohort study of 5,239 older patients with a new primary care visit for back pain.
Investigators compared function and pain at the 12-month follow-up visit among 1,174 patients who had early radiographs, 349 patients who had early MRI/CT, and 3,719 controls.
The primary outcome was back or leg pain-related disability, as measured by a back and leg pain disability score. The mean score showed no significant differences between groups.
COMMENTARY
Many guidelines suggest consideration of imaging early on in the diagnosis of low back pain in older adults due to the high prevalence of important underlying causes such as cancer.1 This study looked at an older population and showed, as has been demonstrated in younger populations, that there is no advantage to early imaging with either x-ray or MRI, though costs were about 25% higher. —NS
REFERENCE
1. Davis PC, Wippold FJ II, Brunberg JA, et al. ACR Appropriateness Criteria on low back pain. J Am Coll Radiol. 2009;6(6):401-407.
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