Friday, 21 Feb 2020

You are here

Most Clinicians Do Not Order MRI/CT for Nonspecific Low Back Pain

Low back pain (LBP) is a highly prevalent public health problem. Not surprisingly, imaging of LBP is also an expensive and often overused diagnostic tool.  

Researchers from the Department of Veterans Affairs (VA) sought to define the problem and formulate recommendations to avoid ordering imaging tests for nonspecific LBP.

Using an online survey tool in 2014, they assessed practitioner preferences to imaging in a hypothetical 45-year-old woman with nonspecific LBP without red flag symptoms.

 requested a computed tomographic (CT) or MRI scan. After reading the scenario, respondents were asked how they would respond to the patient’s request and factors that influenced their decision to obtain imaging. Using a 4-point scale, respondents also rated their own difficulty in following the CW recommendations to avoid imaging for nonspecific LBP in the first 6 weeks, and how they perceive patients’ willingness to accept this recommendation. We created a multivariable logistic regression model to identify provider characteristics associated with perceived difficulty in following this recommendation. The VA Ann Arbor Healthcare System institutional review board approved the study, which included a waiver of written informed consent signed by participants, who were not compensated for their participation, but who were entered into a lottery for a chance to win 1 of 30 $100 Amazon gift cards.

Responses were obtained from 579 (response rate, 47.3%) clinicians; 305 (56.2%) were women, 379 (69.5%) were physicians, 130 (23.9%) were nurse practitioners, and 36 (6.6%) were physician assistants.

Only 18 clinicians (3.3%) thought the patient would benefit from having at CT or MRI scan. In addition, Nearly 77% thought such imaging would lead to further unnecessary testing and 76% felt they would be unable to refer the patient to a specialist without obtaining imaging first.  Lastly, 27% thought that not ordering an imaging test could leave them vulnerable to a malpractice claim.

Athough most VA clinicians agreed with the recommendations against ordering imaging for nonspecific LBP, but several perceived barriers may prevent clinicians from following the recommendations in practice.

The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

Half of Opioids Rx Come from 1% of MDs

The BMJ reports that while most US providers are cautious in their prescribing, half of opioid prescriptions are written by 1% of providers.

Between 2003 and 2017, there was an annual average of 669495 providers prescribing 8.9 million opioid prescriptions.

In 2017, 1% of providers accounted for 49% of all opioid doses and 27% of all opioid prescriptions; that's nearly 1000 times more than the middle 1% of prescribers.

Domestic Abuse Linked to Fibromyalgia and Chronic Fatigue

Domestic violence was found to predispose to a higher risk of fibromyalgia and those developing chronic fatigue syndrome.

Researchers studied the association between intimate partner violence (IPV) with fibromyalgia and CFS, using a retrospective open cohort design of patients entered into the “The Heath Improvement Network” database between 1995 and 2017.

A Potential Biomarker for Chronic Fatigue Syndrome Patients

Myalgic encephalomyelitis/chronic fatigue syndrome affects at least 2 million people in the United States and bears tremendous overlap with fibromyalgia - both being difficult to diagnosis because the symptom complex is often unrecognized and these conditions have no biomarker test. 

NIH Conference Review of Chronic Fatigue Syndrome

The current issue of JAMA reviews recent advances on chronic fatigue syndrome, also known as myalgic encephalomyelitis/(ME/CFS), based on a 2-day conference held at the NIH in an April 2019. The NIH 2-day conference reviewed recent progress and new research in several areas described below.

Study Looks at Opioid Use After Knee Surgery

A small study looked at whether reducing the number of opioid tablets prescribed after knee surgery would reduce postoperative use and if preoperative opioid-use education would reduce it even more.