Imaging Earlier for Back Pain Does Not Improve Outcomes

Early spine imaging is not associated with better one-year outcomes among patients presenting with a new primary care visit for back pain and disability, according to a study published in JAMA.

Researchers from the University of Washington in Seattle performed a prospective study to compare function and pain among patients who underwent imaging after presenting with new primary care visit back pain without radiculopathy with those with the same complaints who did not have imaging tests.

A total of 5,239 patients, older than 65 years, were included in the study. The two cohorts were matched for diagnosis, pain severity, pain duration, functional status, and prior resource use, in addition to demographic characteristics. The patients in the imaging group had undergone radiography (1,174 patients), or CT or MRI (349 patients) within six weeks of their index visit.

At the 12-month follow-up, the patients were asked to complete the modified Roland-Morris Disability Questionnaire, providing a score from zero to 24, with higher scores indicating greater disability.

The results showed that the patients who had undergone early radiography scored a mean of 8.54 at follow-up, which was not statistically different from the matched group’s mean score of 8.74. The mean score for the early MRI/CT group was 9.81 compared with the control group’s 10.50.

Despite there being no statistical difference in disability, there were marked differences in one-year resource use and costs, the authors wrote. The estimated monetary differences in one-year total payments (payer and patient contributions) were $1,380 higher for patients with early radiographs and $1,430 higher for patients with early MRI/CTs.[[{"type":"media","view_mode":"media_crop","fid":"33725","attributes":{"alt":"Jeffrey G. Jarvik, MD, MPH","class":"media-image media-image-right","id":"media_crop_9523407133194","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3570","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 124px; width: 100px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Jeffrey G. Jarvik, MD, MPH","typeof":"foaf:Image"}}]]

"Among older adults with a new primary care visit for back pain, early imaging was not associated with better 1-year outcomes,” co-author Jeffrey G. Jarvik, MD, MPH, said in a release. “The value of early diagnostic imaging in older adults for back pain without radiculopathy is uncertain."