What is appropriate medical imaging for low back pain?

Practice points

The key messages for health professionals are:

  • Take a thorough history and examination to assess for the presence of serious clinical conditions (‘red flags’)
  • Use lower lumbar imaging in patients found to have a serious condition or if the patient has radiculopathy or spinal stenosis AND is a candidate for surgery. Reassure patients that low back pain is rarely serious, most pain settles quickly and imaging usually does not often explain the reason for pain
  • Provide adequate analgesia usually starting with  regular paracetamol for short term symptom relief
  • Advise patients to stay active, avoid bed rest and continue as normally as possible

Low back pain is extremely common, affecting four in five Australians at some point in their lives. The pain can be debilitating and people often want to know what’s causing it, but in about 85% of cases the cause is non-specific.

Scan and X-ray orders have increased significantly in  Australia over the last decade. A review of GP activity using the BEACH dataset from 2008-09 showed nearly one in 10 consults led to imaging orders, generating an additional 2.7 million imaging orders than in 1999-2000. In 2008-09 5% of diagnostic imaging related to back pain.

Back Pain Choices tool

The Back Pain Choices tool was jointly developed by The George Institute for Global Health and NPS to assist with the diagnosis and management of lower back pain in primary care. It provides clinical scenarios and an appropriate imaging strategy.

It is a distillation of the recommendations from evidence-based clinical practice guidelines produced by Australia’s National Health and Medical Research Council, The United Kingdom’s National Institute for Health and Clinical Excellence, and the guideline jointly produced by the American Pain Society and American College of Physicians.

 

Resources for your patients

NPS MedicineWise has developed a tool to help health professionals provide advice to their patients on the symptomatic management of acute low back pain. The symptomatic management pad is a one page resource that health professionals can give patients to help appropriately manage back pain.