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Early X-Ray or MRI for Back Pain in Older Adults Not Always Best?

Early imaging for back pain in older adults not associated with better outcomes

Older adults who had spine imaging within six weeks of a new primary care visit for back pain had similar pain and disability during the next year as similar patients who did not undergo early imaging, according to a new study.

Findings appear in an article published in the March 17 issue of JAMA.

When to image older adults with back pain remains controversial, the authors wrote in the article background. Many guidelines recommend older adults undergo early imaging because of the higher prevalence of serious underlying conditions. However, there is not strong evidence to support this recommendation. Adverse consequences of early imaging are more substantial in an older population because the prevalence of incidental findings on spine imaging increases with age. And these incidental findings might lead to a cascade of subsequent interventions that increase costs without benefits, according to background information in the article.

Jeffrey G. Jarvik, MD, MPH, of the University of Washington, Seattle, and colleagues including Sean D. Rundell, DPT, PT, PhD, compared function and pain at the 12-month follow-up visit among older adults who received early imaging (within six weeks) with those who did not.

The study included 5,239 patients ages 65 or older with a new primary care visit for back pain in three U.S. healthcare systems. None of the study participants had radiculopathy — a condition affecting the spinal nerve roots and spinal nerves. Diagnostic imaging — radiographs, computed tomography, magnetic resonance imaging — was of the lumbar or thoracic spine.

Among the patients studied, 1,174 had early radiographs and 349 had early MRI or CT. At 12 months, neither the early radiograph group nor the early MRI/CT group differed significantly from controls on measures of back or leg pain–related disability.

However, the findings showed marked differences in one-year resource use and costs. 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 MRIs or CTs.

“Among older adults with a new primary care visit for back pain, early imaging was not associated with better 1-year outcomes,” the authors wrote. “The value of early diagnostic imaging in older adults for back pain without radiculopathy is uncertain.”

Study abstract: http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2015.1871

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