Use of imaging in low back pain.
Posted 05/04/25
Follow best-practice guidelines to avoid unnecessary interventions.
One of the ways Martin’s Point monitors the quality of care our health plan beneficiaries receive is by tracking claims received for imaging within six weeks of an initial diagnosis of acute back pain.
Low back pain (LBP) is extremely common and, for 85% of people with LBP, it usually resolves in a few weeks.1 Approximately 25% of patients 18 to 50 years of age with acute LBP who underwent imaging exams had no identifiable indication for imaging.2
Guidelines for imaging of patients with LBP have been adopted and published by the American College of Radiology, the National Institute for Health and Clinical Excellence, and the American College of Family Practice, among many others.3,4,5 All stress the following principle:
- Routine imaging of patients with acute LBP should not be undertaken within the first 6 weeks of presentation, unless there are signs and symptoms of severe or progressive neurological deficit, cancer, cauda equina syndrome, infection, or fracture.
- Early advanced imaging studies are indicated for all of the above except fracture.
- Early plain film studies are indicated for fracture suspected after trauma or in the setting of osteoporosis, cancer, or chronic steroid use.
Clinicians are encouraged to take the time to reassure their patients that pain usually improves over time (90–95% of the time) regardless of treatment and discuss the risks and benefits of imaging. A short conversation about the risks of radiation, expected time frames for recovery, and recommended treatments can go a long way in helping inform shared treatment decisions. Clinicians can also educate their patients to access shared-decision-making tools available on our website through Healthwise; explore the comprehensive Healthwise decision-making guide.
Martin’s Point recently performed a study of the records for a statistically significant number of health plan beneficiaries who received imaging within the first six weeks of an initial diagnosis of low back pain. The findings revealed that:
- Providers with ready access to imaging services provide an x-ray on the same day regardless of other conditions.
- Females were more likely to get imaging than males.
We recommend providers assess their practices to ensure adherence to the best-practice imaging guidance noted above.
1Rao D, Scuderi G, Scuderi C, Grewal R, Sandhu SJ. The Use of Imaging in Management of Patients with Low Back Pain. J Clin Imaging Sci. 2018 Aug 24;8:30. doi: 10.4103/jcis.JCIS_16_18. PMID: 30197821; PMCID: PMC6118107.
2National Committee for Quality Assurance. The state of health care quality 2006. Available at: www.ncqa.org (Accessed on October 11, 2011.)
3American College of Radiology, Committee on Appropriateness Criteria, “Low Back Pain,” Originally published 1996, revised 2021. American College of Radiology.
4American Academy of Family Practice, “Imaging for Low Back Pain, Choosing Wisely,” 2023. American Academy of Family Practice.
5American College of Physicians. (2017, February 14). American College of Physicians issue guideline for treating nonradicular low back pain. American College of Physicians.
