“87% of young people have back pain. The other 13% have no computer.” - Unknown
Most of us have experienced back pain at some point. ln fact, low back pain (LBP) is one of the most common conditions, with approximately 25% of U.S. adults experiencing LBP over a three-month period.1 The increase in individuals working remotely has likely exacerbated the situation due to poor ergonomic home set-ups.2
The pain can be quite debilitating, and patients are frequently eager to have an explanation that will explain their pain and help them begin to recover. As a result, LBP commonly drives individuals to seek treatment, which often leads to a physician ordering costly imaging studies, including x-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI) studies.
Abnormalities, mainly due to aging, are often found through these studies. Patients with LBP may be relieved when their physician shows or describes these abnormalities, believing that the source of their pain has been found. Treatment recommendations are made based on the findings, which may include surgery.
You may be surprised to know that despite how often they’re ordered, imaging studies for acute LBP are often cited on lists of common low-value care services - care that contributes to costs or causes additional harm without improving outcomes.
If these studies frequently find real abnormalities, why are they considered low-value services?
It turns out that findings from imaging studies of the spine are often incidental, and not actually associated with the true cause of low back pain. Studies have shown that anatomic abnormalities on imaging studies become increasingly common as we age (over half of 30-year-olds have abnormalities) and are just as common in asymptomatic individuals as in individuals with low back pain.3
In other words, despite the relief of receiving an explanation for a patient’s pain, the explanation may not be the correct one, and may lead to a less than optimal treatment path.
Acute back pain is commonly due to muscle strain, which is not identified with imaging. Furthermore, most individuals will improve from conservative treatment within a few weeks, rendering the studies unnecessary unless pain persists.
Imaging for low back pain can lead to other harm and costs, including:
Like most forms of low-value care, use of spine imaging is clinically nuanced. Imaging may be necessary when pain does not improve after four to six weeks of conservative care, or sooner in patients who are found to have severe or progressive neurologic deficits, fever, trauma, or serious underlying medical conditions like cancer.
Magnitude of the Problem
The magnitude of the problem in the United States has been estimated at about 1.6 million avoidable imaging services annually for low back pain with an aggregate cost of about $500 million.5
Related costs for lower back imaging tests and potential surgical procedures, based on the 2020 Springbuk Book of Business, include
Actions Employers Can Take
Employer actions that can reduce both costs and harms of unnecessary low back imaging include:
Low back pain is a common condition that usually resolves within a few weeks. Much of the imaging related to LBP is unnecessary, costly, and has the potential to cause harm.
Employer actions can reduce wasteful spending due to unnecessary low back pain imaging. Low Value Care Insights cards, available in the Springbuk health data analytics platform, provide information related to occurrences and potential strategies to reduce low back pain imaging, other unnecessary imaging procedures, antibiotic misuse, and non-recommended screening exams.