Examining back pain using imaging techniques?

The reason for generalised back pain can be tension in the back muscles, weakness in the trunk or poor posture. Serious illnesses are rarely the cause of this type of pain.

The Harding Centre for Risk Literacy at the University of Potsdam has summarised the potential benefits and detriments of imaging procedures for back pain based on scientific studies. In several studies, adults with long-lasting, non-specific upper and lower back pain were monitored for up to two years.

Influence on mobility and quality of life

Over time, the same number of people, regardless of whether or not they had been examined using imaging techniques, felt their general mobility and quality of life improve once more over time.

Risks of imaging techniques

Excessive use of imaging can result in harm to patients. This is because the overuse of X-rays and CT scans exposes patients to potentially mutagenic radiation. In addition, imaging sometimes yields erroneous or incidental findings, such as detecting deterioration of the spine. Yet such findings may be unrelated to the cause of the pain. In extreme cases, findings can result in unnecessary operations.

In the case of generalised back pain, imaging does not contribute to improving general mobility and quality of life.

The best option may be to initially refrain from imaging and focus on providing advice and educating patients to mitigate the possible causes. These include measures to boost physical activity in everyday life and to encourage self-management, such as dealing with stress.

Non-drug treatments – for example, physiotherapy, manual therapy or acupuncture – can also help relieve pain.

If patients experience pain for more than six weeks, or if it worsens or increasingly restricts their mobility, imaging may then be worth considering. Likewise, if they develop signs of paralysis or numbness, an imaging procedure is advisable.