Many physicians order MRI and other diagnostic tests too soon for most back pain conditions

Advancements in medical science have enabled physicians and other healthcare providers to better treat their patients. From advanced imaging systems that allow clinicians to identify underlying pathology to revolutionary medications and other treatment methods that help people recover quicker, today’s healthcare provider has all the benefits of modern technology at his or her fingertips.

But, is all this technology necessary and does it affect the long term outcome of the patient? The answer may surprise you.

Here are a few articles from NPR Health, The Fiscal Times, and The Journal of the American Board of Family Medicine that look to answer this question.

Physicians Asked To Prescribe Less

NPR health looks at 5 things family physicians and internists should NOT do as published by the Archives of Internal Medicine.

The Top 5 list for them goes like this:

  1. No MRI or other imaging tests for low back pain, unless it has persisted longer than six weks or there are red flags, such as neurological problems.
  2. No antibiotics for mild to moderate sinusitis, unless it has lasted a week or long. Or the condition worsens after first getting better.
  3. No annual electrocardiograms for low-risk patients without cardiac symptoms.
  4. No Pap tests in patients under 21, or women who’ve had hysterectomies for non-malignant disease.
  5. No bone scans for women under 65 or men under 70, unless they have specific risk factors.
  6. (Full article here)

Are Medical Tests Unnecessary?

It’s estimated that between 20% and 33% of the medical tests and treatments we get are unnecessary, costing billions and leading to dangerous side effects.

WASHINGTON (AP) — More medical care won’t necessarily make you healthier — it may make you sicker. It’s an idea that technology-loving Americans find hard to believe.

Anywhere from one-fifth to nearly one-third of the tests and treatments we get are estimated to be unnecessary, and avoidable care is costly in more ways than the bill: It may lead to dangerous side effects.

It can start during birth, as some of the nation’s increasing C-sections are triggered by controversial fetal monitors that signal a baby is in trouble when really everything’s fine.

It extends to often futile intensive care at the end of the life.

In between:
—Americans get the most medical radiation in the world, much of it from repeated CT scans. Too many scans increase the risk of cancer.

—Thousands who get stents for blocked heart arteries should have tried medication first.

—Doctors prescribe antibiotics tens of millions of times for viruses such as colds that the drugs can’t help.

—As major health groups warn of the limitations of prostate cancer screening, even in middle age, one-third of men over 75 get routine PSA tests despite guidelines that say most are too old to benefit. Millions of women at low risk of cervical cancer get more frequent Pap smears than recommended; millions more have been screened even after losing the cervix to a hysterectomy.

—Back pain stands out as the No. 1 overtreated condition, from repeated MRI scans that can’t pinpoint the trouble to spine surgery on people who could have gotten better without it. About one in five who gets that first back operation will wind up having another in the next decade. (Read full article)

More Medicine Won’t Improve Outcomes For Patients With Chronic Back Pain

Richard A. Deyo, MD, MPH, ot the Department of Medicine, Oregon Health and Science University, investigates the impact back pain has had on the rapidly expanding range of tests and treatments.

Prescribing yet more imaging, opioids, injections, and operations is not likely to improve outcomes for patients with chronic back pain. We must rethink chronic back pain at fundamental levels. Our understanding of chronic back pain mechanisms remains rudimentary, including our knowledge of spinal biology, central nervous system processing, genetic factors, and psychosocial and environmental influences. Greater investment is needed in this basic science research.

Clinicians may often be applying an acute care model to a chronic condition. There are no “magic bullets” for chronic back pain, and expecting a cure from a drug, injection, or operation is generally wishful thinking. These approaches risk overlooking the psychosocial, occupational, and lifestyle dimensions of chronic pain. Although evidence remains incomplete and the magnitude of benefits may be modest, data support the benefits of interventions that promote patient involvement and activity (eg, graded exercise programs and group support).73–77 These therapies also have the advantage of being low risk.

A “chronic care model” would acknowledge that chronic back pain, like diabetes or asthma, is a condition we can treat but rarely cure. As with other chronic conditions, care of chronic back pain may benefit from sustained commitment from health care providers; involvement of patients as partners in their care; education in self-care strategies; coordination of care; and involvement of community resources to promote exercise, provide social support, and facilitate a return to work. Patients need realistic expectations despite product marketing, media reports, and medical rhetoric that promise a pain-free life. (Read full article)

We’d love to hear your experience with treatment or diagnostic studies that you may have thought to be unnecessary. Leave a comment below to share your thoughts.

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