Appropriateness of Imaging in Chronic Low Back Pain
The majority of the patients suffering low back pain will receive routine spinal imaging (lumbar radiography, computed tomography [CT], or magnetic resonance imaging [MRI]) as part of the initial management program. However, the American College of Physicians (ACP) and the American Pain Society (APS) recommend only to perform imaging for patients who have severe or progressive neurologic deficits or signs or symptoms suggesting a serious underlying condition. These recommendations can be justified by the fact that routine imaging does not seem to improve clinical outcomes, exposes patients to unnecessary harms, and increases the cost of low back pain management. Diagnostic studies and specifically imaging studies should address a number of questions with regard to the technical efficacy, the diagnostic accuracy, the therapeutic impact, and the clinical efficacy.
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