Q: I’m 72 years old. I had sudden onset of low back pain one week ago for the first time. It’s only a little better. My doctor said I did not need an x-ray or other imaging test. Is that normal?
A: Based on a recent study, your doctor is correct. Unless you have any other symptoms in addition to low back pain, an x-ray, CT scan or MRI would not affect your outcome, while it could cost you a lot of money.
The study followed more than 5,200 men and women over the age of 65 who saw a primary care physician for a new bout of back pain. More than 1,500 of them had some type of back scan within six weeks of the first doctor visit.
After reviewing medical records and questionnaires the study participants completed, the researchers found that people who got early scans did no better than those who didn’t have scans. The scans added about $1,400 per person to the overall cost of back pain care — with no measurable benefit. The results were published in theMarch 18 issue of the Journal of the American Medical Association.
Low back pain is very common. Most people will have at least one bout of serious back pain at some point in their lives. More often than not, the reason for the pain is never identified. And most of the time, the pain gets better on its own.
A common-sense approach to new back pain works for almost everyone, including older adults: Wait for a bit, use simple strategies to ease the pain, and monitor what happens.
There are, of course, exceptions. An individual with new back pain who also has symptoms or signs that could indicate a fracture, cancer, infection, or other serious problem should get an early imaging test, such as a spine x-ray, CT scan, or MRI. So-called red flags include:
1. Back pain with a fever
2. Back pain in someone who has cancer
3. Back pain that wakes you from sleep (not just waking up and realizing your back still hurts, but pain that wakes you up)
4. Back pain after an injury
5. Back pain with loss of control of urine or stool.
If the pain gets worse or persists for more than several weeks, make another appointment with your doctor. It’s still unlikely that anything serious is causing the pain.
(Howard LeWine, M.D., is a practicing internist at Brigham andWomens Hospital in Boston and Chief Medical Editor of Internet Publishing at Harvard Health Publications, Harvard Medical School.)
(For additional consumer health information, please visitwww.health.harvard.edu.)
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