Choosing Wisely:

Avoid imaging studies (MRI, CT or X-rays) for acute low back pain without specific indications.

Rationale and Comments: Imaging for low back pain in the first six weeks after pain begins should be avoided in the absence of specific clinical indications (e.g., history of cancer with potential metastases, known aortic aneurysm, progressive neurologic deficit). Most low back pain does not need imaging and doing so may reveal incidental findings that divert attention and increase the risk of having unhelpful surgery.
Sponsoring Organizations:
  • American Society of Anesthesiologists
  • Sources:
  • ACP/APS guidelines
  • Disciplines:
  • Orthopedic
  • References: • Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009;373(9662):463–72.
    • Chou R, Qaseem A, Snow V, Casey D, Cross JT, Shekelle P, Owens DK; Clinical Efficacy Assessment Subcommittee of the American College of Physicians; American College of Physicians; American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478–91.
    • Davis PC, Wippold FJ, Brunberg JA, Cornelius RS, De La Paz RL, Dormont PD, Gray L, Jordan JE, Mukherji SK, Seidenwurm DJ, Turski PA, Zimmerman RD, Sloan MA. ACR appropriateness criteria on low back pain. J Am Coll Radiol. 2009;6(6):401–7.
    • Kendrick D, Fielding K, Bentley E, Miller P, Kerslake R, Pringle M. The role of radiography in primary care patients with low back pain of at least 6 weeks duration: a randomized (unblended) controlled trial. Health Technol Assess. 2001;5(30):1–69.
    • Miller P, Kendrick D, Bentley E, Fielding K. Cost-effectiveness of lumbar spine radiography in primary care patients with low back pain. Spine. 2002;27(20):2291–7.

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