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How helpful or beneficial is the use of imaging techniques in diagnosing back pain?

When patients present with back pain, they are often examined using imaging techniques such as x-ray or computer tomography scans. But how beneficial are they really?

On average, eight out of ten people in Switzerland will experience non-specific back pain once in their lifetime. Experts differentiate between specific and non-specific back pain. Specific back pain can be traced to an accident or illness. The pain caused by a slipped disc is a classic example of specific back pain. Non-specific back pain, on the other hand, could be caused by muscle tension, a weak core or incorrect posture. Experts further differentiate between acute, subacute and chronic pain. Pain that diminishes within six to twelve weeks is considered acute or subacute. If it persists for more than twelve weeks, it is considered to be chronic.

In their attempts to find the cause of a patient's back pain, doctors frequently use various types of imaging techniques available. While x-rays produce an image of the patient's bones and joints, computer tomography (CT) scans also show their ligaments, tendons and spinal discs. Magnetic resonance imaging (MRI) goes one step further, producing detailed views of the patient's soft tissue and spinal cord. Imaging techniques also harbour certain risks, though, as patients are exposed to doses of radiation that should not be underestimated, especially during x-rays and CT scans. This radiation can cause cell mutations and increase the risk of cancer. Patients may also receive wrong or accidental diagnoses of, for example, degenerative changes to the spinal column, which do not have to be the cause of their non-specific back pain. In extreme cases, such wrong diagnoses could even result in unnecessary surgical interventions.

When imaging techniques should be used

So when does it make sense – after weighing up the risks and benefits – to use an imaging technique? Several studies have looked into this question, including one conducted by the Harding Centre for Risk Literacy at the Max Planck Institute for Human Development that followed adults with chronic, non-specific back pain for up to two years.
In cases of acute, non-specific back pain, it is safe to simply wait for up to six weeks. The use of imaging techniques is not necessary. In a comparison of patients who had been examined using imaging techniques and patients who had not, the same number of patients in each group reported an improvement in their back pain, mobility and quality of life. The same number of patients also expressed satisfaction with their treatment.

The cause for acute, non-specific back pain is often to be found in lifestyle factors, and simple measures such as being more active or managing stress can alleviate symptoms. Medication-based treatment with painkillers as well as medication-free approaches such as physiotherapy or acupuncture can also relieve pain.

However, if the pain worsens, restricts a patient's mobility and comes with signs of paralysis, and there are indications of a serious condition, the use of imaging techniques can be beneficial.

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