X-Rays Deemed Unnecessary
for Most Low Back Pain

NEW YORK (Reuters Health) - Getting an x-ray to uncover the source of lower back pain does not reduce suffering, researchers report. In fact, in a new study, patients who had an x-ray, or radiography, reported more pain 3 months later than those who did not have an x-ray.

``There is no evidence that having radiography helps doctors to care for people with simple back pain,'' according to one of the study's authors, Dr. Mike Pringle, of the School of Community Health Sciences at University Park in Nottingham, UK.

``Indeed, the evidence is that the act of having an x-ray can, perhaps by appearing to increase the perception of severity, delay recovery,'' he told Reuters Health.

Low back pain is a common medical problem, and doctors often x-ray the lower spine to diagnose the cause of the pain. In most cases, however, x-ray results do little to change the treatment of back pain, Pringle and his colleagues note in an article in the February 17th issue of the British Medical Journal. Most of the time, x-rays are performed to reassure patients or doctors, according to the researchers.

To test the benefits of x-rays, Pringle's team conducted a study of 421 people with low back pain that had lasted for an average of 10 weeks. All patients received the standard care for low back pain, but half of the patients were randomly assigned to have an x-ray of their lower spine.

Three months later, back pain had improved on average in both groups, but patients who had been x-rayed were more likely to still be suffering from back pain and to have poorer overall health. These patients were also somewhat more likely to complain of more severe pain and to have their back pain interfere with their normal activities.

But even though x-rays did not appear to help relieve back pain, more than 80% of patients in both groups said they would choose to have an x-ray if they could.

By 9 months, most of the differences between the groups diminished, although having an x-ray still did not appear to provide any benefits, the report indicates. Patients in the x-ray group tended to be more satisfied with their care, however.

The findings highlight the need to let people know that x-rays are of little use to most people with low back pain, according to Pringle.

``Since so many people believe that radiography is an essential feature of the management of back pain, there is a need for a campaign to inform the public,'' he said.

When doctors order an x-ray to investigate low back pain, patients may interpret the move as a sign that they really are unwell, so they may be more likely to report pain and to think that the pain interferes with their activities, Pringle's team notes in the report.

Getting the message out that x-rays do little to relieve low back pain may reduce demands on the healthcare system, according to the authors, who report that patients who were x-rayed went to the doctor more frequently during the first 3 months of the study.

SOURCE: British Medical Journal 2001;322:400-405.

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