Can we reduce the use of imaging for low-back pain?

Guidelines for the treatment of low back pain advise against routinely referring patients for imaging. However, in the past two decades the number of patients referred for imaging continues to increase. Not only does  this increase the cost of care for low back pain but unnecessary imaging for low back pain has been found to be associated with poor outcomes. It is therefore important to educate practitioners to only refer patients for imaging when necessary to improve outcomes and reduce costs.


It is unclear what is the most effective method to reduce the rate of referral for imaging. This review examined the relative effectiveness of several methods at reducing the rate of referral for imaging. The two most effective methods are (i) clinical decision support using a modified referral form and (ii) targeted reminders of the appropriate indications for imaging. Other methods did not appear to reduce the  rate of referrals.

The review indicates that there are simple strategies that may be used to reduce imaging rates which could substantially reduce expenses associated with low back pain management


Hazel Jenkins is a PhD candidate in Macquarie University, Sydney. Her PhD project involves looking at the rates of imaging in the management of low back pain and assessing strategies currently used to decrease imaging use. Her aim is to develop and trial an intervention directed at both clinicians and their patients to decrease the referral for imaging that is not clinically indicated.

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