Low back pain is the fifth most common reason for all physician visits and the second most common affliction after the common cold. Low back pain disables 5.4 million Americans and costs at least $90 billion each year in medical and non-medical expenses per year.1
Low back pain diagnoses are generally determined through medical history and a physical exam and rarely require expensive or uncomfortable tests. Exercise, physical therapy, medication, rest and application of heat or cold are effective therapies for low back pain. If these therapies are ineffective, X-rays, MRIs and other diagnostic tests are appropriate alternatives. In some instances, these tests may be a first line of treatment, but such cases represent a small fraction of low back pain diagnoses.
In their Choosing Wisely campaign to educate patients and providers, the American Academy of Family Physicians recommends the following:
No imaging for low back pain within the first six weeks, unless the following red flags are present:
Severe or progressive neurological deficits
Suspected serious underlying conditions such as osteomyelitis2
Imaging of the lower spine before six weeks. This procedure does not improve outcomes but does increase costs and involve unnecessary radiation exposure.