This is the message being promoted by a major physicians group from the US. The American College of Physicians is claiming that X-rays, CT scans and MRI's are routinely ordered for patients with acute low back pain, but may be unnecessary. What's more, the college is reminding people that these scans are not without risks. All of the above mentioned imaging techniques expose patients to radiation.
Another concern brought up this doctors group is the presence of 'false positives'. What that means is that using these scans whether it be X-rays, CT scans or MRI's, can expose findings that may be completely unrelated to a patient's symptoms. For example, it is possible to see what appears to be abnormalities in scans, such as bulging discs, while the patient reports no symptoms at all. However, once such abnormalities are uncovered, they may be treated, potentially with an unneeded surgery, experts say.
This of course, brings up the problem of cost. "Health-care costs are increasing unsustainably, and a crucial concern for everyone is how do we maintain or improve the quality of care without increasing costs? One way is for physicians to stop ordering tests that may not be beneficial," said Dr. Amir Qaseem, one of the authors of the back pain guidelines, and director of clinical policy in the medical education division of the American College of Physicians (ACP) in Philadelphia.
The new guidelines on diagnostic imaging for people with low back pain are published in the Feb. 1 issue of the Annals of Internal Medicine.
Here is some more sobering information about imaging and back pain. Low back pain is very common in society today. In fact just about everyone will suffer a severe bout of low back pain in their lives according to the U.S. National Institute for Neurological Disorders and Stroke. Data from the ACP states that about $90 billion a year is spent on treating low back pain in the US alone. In 1997, the average cost of treating a low back pain patient was reported at $4,795. By 2005, this cost had ballooned to $6,096!!
Unfortunately, for patients increasing cost does not seem to be resulting in better outcomes. The ACP cites findings from six different studies that conclude that patients with spine problems that got radiological studies did not significantly benefit. To be more precise, these patients reported similar or WORSE scores on quality of life and physical assessments scores compared to people who did not undergo scans. The ACP went on to add that abnormal findings often do not change treatment plans for patients. In addition, it is very difficult to say with certainty that an abnormal finding on a scan is indeed the cause of the patient's pain. To shine a spotlight on this point, a study conducted on patients over the age of 60 who did NOT have back pain was surprising. The study found that about 90% of these subjects showed signs of spinal degeneration or bulging discs on scans, even though they did not complain of any symptoms.
Now as an aside, I am not one promoting the idea of forgoing scans altogether. I think in certain situations an X-ray, CT scan or MRI is absolutely crucial to the proper diagnosis and treatment of a patient's complaint. However, in my practice I have encountered dozens of patients who's doctors ordered an X-ray only to come back negative of any findings at all. As one can see, this can be very frustrating to patients because they truly are having pain and dysfunction but seem no closer to an answer.
In my practice, I use a series of physical exam procedures and orthopedic tests to reach a diagnosis. This method is like working backwards, so instead of trying to find out where a problem is coming from, I try to rule out possibilities so I know what it isn't. Admittedly, this process is not 100%. In fact it's nearly impossible to name a test/procedure/protocol that is 100%. But I can say, the results I have seen in my clinic have been very good for my patients and no radiation required!
If you're in the Commercial Drive area of East Vancouver, stop by the office or visit the website;COMMERCIAL DRIVE - EAST VANCOUVER CHIROPRACTOR;DR. DOMINIC CHAN DC.
Amir Qaseem, M.D., Ph.D., director, clinical policy, medical education division, American College of Physicians, Philadelphia; Anders Cohen, M.D., chief, neurosurgery and spine surgery, The Brooklyn Hospital Center, New York City; Feb. 1, 2011, Annals of Internal Medicine
Unfortunately, for patients increasing cost does not seem to be resulting in better outcomes. The ACP cites findings from six different studies that conclude that patients with spine problems that got radiological studies did not significantly benefit. To be more precise, these patients reported similar or WORSE scores on quality of life and physical assessments scores compared to people who did not undergo scans. The ACP went on to add that abnormal findings often do not change treatment plans for patients. In addition, it is very difficult to say with certainty that an abnormal finding on a scan is indeed the cause of the patient's pain. To shine a spotlight on this point, a study conducted on patients over the age of 60 who did NOT have back pain was surprising. The study found that about 90% of these subjects showed signs of spinal degeneration or bulging discs on scans, even though they did not complain of any symptoms.
Now as an aside, I am not one promoting the idea of forgoing scans altogether. I think in certain situations an X-ray, CT scan or MRI is absolutely crucial to the proper diagnosis and treatment of a patient's complaint. However, in my practice I have encountered dozens of patients who's doctors ordered an X-ray only to come back negative of any findings at all. As one can see, this can be very frustrating to patients because they truly are having pain and dysfunction but seem no closer to an answer.
In my practice, I use a series of physical exam procedures and orthopedic tests to reach a diagnosis. This method is like working backwards, so instead of trying to find out where a problem is coming from, I try to rule out possibilities so I know what it isn't. Admittedly, this process is not 100%. In fact it's nearly impossible to name a test/procedure/protocol that is 100%. But I can say, the results I have seen in my clinic have been very good for my patients and no radiation required!
If you're in the Commercial Drive area of East Vancouver, stop by the office or visit the website;COMMERCIAL DRIVE - EAST VANCOUVER CHIROPRACTOR;DR. DOMINIC CHAN DC.
Amir Qaseem, M.D., Ph.D., director, clinical policy, medical education division, American College of Physicians, Philadelphia; Anders Cohen, M.D., chief, neurosurgery and spine surgery, The Brooklyn Hospital Center, New York City; Feb. 1, 2011, Annals of Internal Medicine
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