Early scans for back pain add cost but offer little benefit for seniors

Older adults with new back pain usually end up getting a CT scan or MRI. That’s often a waste of time and money and has little or no effect on the outcome, according to a new study from the University of Washington.

The results contradict current guidelines from the American College of Radiology. The guidelines say that it’s “appropriate” for doctors to order early MRIs for people ages 70 and older with new-onset back pain, and many doctors do just that.

The study followed more than 5,200 men and women over the age of 65 who saw a primary care physician for a new bout of back pain. More than 1,500 of them had some type of back scan within six weeks of the first doctor visit. After reviewing medical records and questionnaires the study participants completed, the researchers found that people who got early scans did no better than those who didn’t have scans. The scans added about $1,400 per person to the overall cost of back pain care — with no measurable benefit. The results were published in this week’s Journal of the American Medical Association.

Watch for red flags

Back pain, especially low back pain, is very common. Most people will have at least one bout of serious back pain at some point in their lives. More often than not, the reason for the pain is never identified. And most of the time the pain gets better on its own.

The University of Washington study offers a common-sense approach to new back pain in most older adults: wait for a bit, use simple strategies to ease the pain, and monitor what happens.

There are, of course, exceptions. An individual with new back pain who also has symptoms or signs that could indicate a fracture, cancer, infection, or other serious problem should get an early imaging test, such as a spine x-ray, CT scan, or MRI. So-called red flags include:

• back pain with a fever
• back pain in someone who has cancer
• back pain that wakes you from sleep (not just waking up and realizing your back still hurts, but pain that wakes you up)
• back pain after an injury
• back pain with loss of control of urine or stool

Just say no to an early back scan

Back pain can be very severe. If you haven’t had it before, it can be frightening. It’s natural to want to know why it is happening. Having a CT scan, MRI, or x-ray of the back might seem like it could pinpoint the problem and guide the way to treatment. But as the University of Washington researchers and others have shown, these scans help only the small percentage of people with new-onset back pain accompanied by red-flag symptoms.

Say the imaging test shows a bulging disc or some other change. It could be the cause of your back pain. More likely, though, it isn’t. There is a good chance that treatment will be directed at what shows up on the scan, and it either won’t ease the pain or will make the problem worse.

Easing back pain

There is no single best remedy for new-onset back pain. Staying in bed for a long time usually makes it worse. Here are some better strategies you can try:

• Try to get up and move around every few hours. Stand and sit until you become too uncomfortable, then lie down again. Try to do a little more each time you get up.
• When you are lying down, position your body and legs in a way that feels most comfortable. Try lying on your side with a pillow placed between bent knees, or lying on your back with two or three pillows under your knees.
• Hot, cold, or neither is a personal preference. If your back pain is clearly injury-related, try applying ice or cold packs for a few minutes several times a day. The cold will help ease inflammation and numb pain. After a few days, switch to heat. Lying on a heating pad on a low setting can feel good.
• For most people, acetaminophen (Tylenol) is the safest over-the-counter pain reliever. Don’t take more than 6 extra-strength (500 milligram) pills or 8 regular-strength (325 milligram) pills in a 24-hour period. Ibuprofen (Advil and others) and naproxen (Aleve and others) are also options, but they can have more serious side effects, especially in seniors.