Ten tips to consider if imaging is recommended for low back pain

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It happens that in Cyprus, MRI usage for diagnostic purposes is very common. Most orthopedics are prescribing MRI's for diagnosis of all conditions either acute or chronic conditions. As Flynn et al. 2011 depict, an MRI and other diagnostic tools can be unnecessary most of the times and at the same time can have a negative effects on the patient.

Ten key points to consider for appropriate use of imaging are:

  1. Clinicians should not recommend diagnostic imaging to non-specific LBP. Diagnostic imaging must be performed only if severe or progressive neurological disorder is present. Clinicians should use diagnostic imaging in evaluating persisting LBP.
  2. History of cancer with new onset of LBP, vertebral infection, cauda equina syndrome and progressive motor weakness are the 4 major serious pathologies (red flags) that need an MRI investigation.
  3. Imaging should not at all times guide therapeutic decision making.
  4. Early imaging cannot identify a precise cause most of the times.
  5. MRI can facilitate "medicalization"of LBP, due to pathoanatomy.
  6. Increased risk of surgery and labeling patients can derive from over-imaging.
  7. Imaging is harmful to health due to radiation.
  8. Telling patients that have an"imaging abnormality" has negative effects.
  9. Physical therapy is an efficient method of diagnosing LBP disorders.
  10. Appropriate imaging and the integration of the imaging findings in the overall context of patient's function and disability are essential elements of patient education and they are part of any physical therapy regime.

The bottom line is to consider an MRI only if there are major pathologies present. Physical therapy is valuable for diagnosis and treatment of LBP.