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Low back pain...when should i get imaging?

Updated: Dec 8, 2019

picture of a women at physiotherapy clinic for low back pain
Many people suffer from back pain

Informed appropriate imaging for low back pain (LBP) management: A narrative review

Low back pain affects two-thirds of adults in their lifetime. Low back pain can be considered any pain originating between the lower ribs and the creases of the buttocks. Most of the time the specific nociceptive (pain) source cannot be identified, however, the authors have made a helpful table that puts back pain into four categories:

1. Non-specific low back pain

2. LBP associated with radiculopathy or stenosis

3. LBP referred from a non-spinal source

4. LBP associated with other spinal causes

Non-specific or sprain/strain LBP accounts for 70% of all LBP cases according to the authors. Mechanical (ie. OA, discs, facets, stenosis or fracture) accounts for 27%, forms of cancer or osteomyelitis, etc. 1%, and visceral referral is the last 2% of all cases.

It is the recommendation of the authors that individuals having the following should seek imaging: LBP for >6 weeks with persistent radiculopathic symptoms, or notable degrading neurological signs and symptoms, and where conservative management has failed.

Lumbar imaging abnormalities are common in individuals without low back pain and are only loosely related to symptoms. The presence of abnormalities does not mean that they are responsible for the individual’s symptoms.

A recent systematic review provides strong evidence that most episodes of LBP improve substantially within 6 weeks, and, by 12 months, average pain levels are

low. Most cases of disc herniation reabsorb or regress by 8 weeks after symptom onset, and it was found that larger herniations seemed to reabsorb or regress better.

Treatment should begin with nonpharmacological care, including self-management, exercise, education, physical and psychological therapies, complementary treatments such as acupuncture, massage, spinal manipulation, superficial heat, yoga and Tai Chi. Patients should be educated about the nature of LBP with or without sciatica, and encouraged to continue normal activities to the best of their abilities and not partake in bed rest.

Wáng, Y. X. J., Wu, A. M., Santiago, F. R., & Nogueira-Barbosa, M. H. (2018). Informed appropriate imaging for low back pain management: A narrative review. Journal of orthopaedic translation.

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