Low back pain (LBP) is one of the most common causes of physician visits in the United States and it is tempting to proceed to imaging quickly. New technologies, such as MRI, have been quickly adopted without requisite experimental or literature support. However, several randomized clinical trials have shown that among patients without clinical signs and symptoms indicating serious underlying conditions, early imaging before a trial of conservative therapy, does not improve overall outcomes. It must be remembered that the as many as 70% of acute LBP patients, especially younger patients without accompanying symptoms and signs, merely have spinal muscle strain or sprain On the other hand, where there are signs, such as sacroiliac joint pain, MRI is the method of choice with sensitivity of 25–85% and specificity of 90–100%. Other signs pointing to radiation of pain, neurological symptoms or a space occupying lesion, such as tumor or abscess, also argue for prompt imaging.
In 1994,Agency for Health Care Policy and Research (AHCPR) published a set of guidelines to assist physicians in the management of LBP less than 3 months in duration.This guidelienw assubsequnetly revised. The European Commission, Research Directorate-General, Department of Policy, Coordination, and Strategy and the American College of Physicians and the American Pain Society published LBP management guidelines as well. All these guidelines emphasize the importance of a focused history and thorough physical examination before any imaging is ordered. In addition, all agree that for patients with acute LBP and without any risk factor for serious spine abnormalities, imaging within the initial 4–8 weeks should not be performed. After this period, with conservative management tried and ineffective, imaging is appropriate.
Chou R, Qaseem A, Owens DK, Shekelle P; for the Clinical Guidelines Committee of the American College of Physicians. Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care From the American College of Physicians. Ann Intern Med. 2011 Feb 1;154(3):181-189.
Katz JN, Harris MB. Clinical practice. Lumbar spinal stenosis. N Engl J Med. 2008;358(8):818-825. Verified as current
The Spine. In: Grainger RC, Allison D, Adam, Dixon AK, eds. Diagnostic Radiology: A Textbook of Medical Imaging. 5th ed. New York, NY: Churchill Livingstone; 2008:chap 60 verified as current
Bahman Roudsari1,2 and Jeffrey G. JarvikLumbar Spine MRI for Low Back Pain: Indications and Yield
American Journal of Roentgenology AJR September 2010 vol. 195 no. 3 550-559
Chou R, Fu RW, Carrino JA, et al. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet2009 ; 373:463 –472
For Lay version see here
About Legal standards for narcotics for pain here