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

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.