Do we need imaging tests for lower-back pain?
Most people will experience acute lower-back pain at some point in their lives. The pain can range from mild, where you are still able to manage most day-to-day activities, to severe, where you cannot get out of bed.
Acute back pain tends to resolve within 1 month, although it can last 6 to 12 weeks, and can be localised or radiate down one or both legs (this is called sciatica).
When more is not always better
It is normal to feel worried or frustrated about back pain and to want to look for the cause of your discomfort, with tests such as X-rays, CT scans or magnetic resonance imaging (MRI).
However, research has shown that imaging tests:
- are often unhelpful in identifying the cause of pain
- in most cases will not change the type of treatment recommended
- do not lead to greater improvement in pain or physical functioning.
In fact, people who had imaging to investigate lower-back pain within the first month did not recover any faster than those who received care from a health professional without imaging.
Imaging can have risks
Imaging sometimes detected abnormalities which turned out to be unrelated to the pain and just part of the normal ageing process.
These findings can lead to further investigations and unnecessary costs, with no beneficial effect on the pain. Imaging for lower-back pain may also deliver radiation to the reproductive organs, and this increased exposure carries risks.
Waiting to see if your pain resolves in a month avoids these risks.
It is ok to ask questions about tests, treatments and procedures
Choosing Wisely Australia is an initiative that is challenging the idea that more health care is always better.
The initiative is encouraging the general public and clinicians to work together to improve the quality of healthcare through considering tests, treatments, and procedures where evidence shows they provide no benefit or, in some cases, lead to harm. When discussing the need for tests for your back pain, you might find it helpful to ask the following questions:
- How will the test help my back pain?
- What are the risks of the test?
- Are there simpler, safer options?
- What happens if I don’t do the test?
- What are the costs?
Managing your back pain
Although the cause of acute lower-back pain often remains unknown, the good news is there are simple and effective actions that can help with recovery.
Sensible tips for managing your back pain include:
Keep moving: Initially you may need to reduce your activity for a few days, but as soon as you are able to move, stay as active as possible within your pain limits. Avoid twisting or bending, especially when lifting.
Control the pain: First, try hot or cold packs, or simple pain relievers that you can get without a prescription, such as paracetamol or non-steroidal anti- inflammatories. If this is not working, see your doctor. They may prescribe a muscle relaxant, or refer you to a physiotherapist who can teach you exercises that help back pain. For some people, acupuncture can be a beneficial treatment in combination with pain relief medicine or physiotherapy.
Stay positive: Pain can make you feel worried or frustrated. Remind yourself that the pain is temporary and you will be back to normal within a few weeks. Try using
deep breathing and mindfulness techniques to cope with the pain.
If the pain persists: If the pain does not improve after using these methods, or persists beyond 6 weeks, see your doctor. They may recommend tests to rule out any underlying cause, and prescribe pain relief medicines.
Acute lower-back pain is a common condition that often resolves within 1 month without treatment. Try to keep moving, and manage your pain with medicines you can get without a prescription. If the pain doesn’t improve, see your doctor who may recommend tests and treatment.
To find out more about the Choosing Wisely Australia initiative, including 5 questions to ask before you get any test, treatment or procedure, and lists of recommendations of tests, treatments, and procedures that clinicians and consumers should question, go to www.choosingwisely.org.au
Last Reviewed: 12/09/2019
Norman Swan Medical Communications