Radiography should not be recommended for low back pain

Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial

Patients with low back pain who have radiography treatment report a longer duration of pain, more severe pain, reduced functioning, and an overall poorer health status than those who do not have radiography, finds a study in this week's BMJ. These findings have important implications for guidelines on managing low back pain, many of which currently recommend radiography.

Researchers in Nottingham identified 421 patients visiting their general practitioner with low back pain. In addition to receiving the usual care provided by the practice, a number of patients were asked to attend their local hospital for a radiograph of the lumbar spine (intervention group). At three months, this group were more likely to report low back pain, perceived their overall health status to be worse, and reported higher pain scale scores. A higher proportion of these patients also consulted their doctor in the three months after radiography. Interestingly, after nine months, satisfaction with care was greater in the group receiving radiography and, overall, 80% of patients in both groups would still have chosen radiography.

One possible explanation for these findings is that radiography encourages or reinforces the patient's belief that they are unwell and may lead to greater reporting of pain and greater limitation of activities, say the authors. Guidelines on managing low back pain should be consistent about not recommending radiography, they conclude.

Contact:

Professor Mike Pringle, School of Community Health Sciences, University Park, Nottingham, UK Email: mike.pringle@nottingham.ac.uk