Lower-Back Pain

Lower-Back Pain


An initiative of the ABIM Foundation

Imaging tests for lower-back pain

Back pain can be excruciating.  So it seems that getting an X-ray, CT scan, or MRI to find the cause would be a good idea.   But that’s usually not the case, at least at first.  Here’s why…

They don’t help you get better faster.

Most people with lower-back pain feel better in about a month whether they get an imaging test or not.  In fact, those tests can lead to additional procedures that complicate recovery.  For example, a study that looked at 1800 people with back pain found that those who had imaging tests soon after reporting the problem fared no better and sometimes did worse than people who took simple steps like applying heat, staying active, and taking an OTC pain reliever.  Another study found that back-pain sufferers who had an MRI in the first month were eight times more likely to have surgery, and had a five-fold increase in medical expenses-but didn’t recover faster.

They can pose risks.

X-rays and CT scans expose you to radiation, which can increase cancer risk.  One study projected 1200 new cancers based on the 2.2 million CT scans of the lower back performed in the U.S. in 2007.  While back X-rays deliver less radiation, they’re still 75 times stronger than a chest X-ray.  That’s especially worrisome to men and women of child bearing age, because X-rays and CT scans of the lower back can expose testicles and ovaries to radiation.  And the tests often reveal spinal abnormalities that could be completely unrelated to the pain. For example, one study found that 90% of older people who reported no back pain still had spinal abnormalities that showed up on MRIs.  Those findings can cause needless worry and lead to unnecessary follow-up tests and procedures such as injections or sometimes even surgery.

They’re often a waste of money.

An X-ray of the lower back ranges from about $200-$290, an MRI from $880-$1230, and a CT scans from $1080 to $1520, according to HealthCareBlueBook.com.  Imaging also accounts for a big chunk of billions Americans spend on lower-back pain each year, not only for the tests themselves, but also the unnecessary interventions they trigger.

When do imaging tests make sense?

It can be a good idea to get an imaging test right away if you have signs of severe or worsening nerve damage, or a serious underlying problem such as cancer or a spinal infection.  Red flags that can make such testing worthwhile include a history of cancer, unexplained weight loss, fever, recent infection, loss of bowel or bladder control, abnormal reflexes, or loss of muscle power or feeling in the legs.  IN other cases, you probably don’t need an imaging test for at least several weeks after the onset of your back pain, and only after you’ve tried the self-care measures described at right.



Most people get over back pain in a few weeks, and these simple steps might help.

1st Consider Alternatives.

If you don’t feel better after four weeks or so, it might be worth talking with your doctor about other options, including osteopathic manipulation, gentle stretching, physical therapy, chiropractic care, yoga, massage, acupuncture, cognitive–behavioral therapy and progressive muscle relaxation.  More invasive choice such as surgery should be considered only if those other treatments don’t help.

Stay Active.

Resting in bed for more than a day or so can cause stiffness, weakness, depression, and slow recovery.

Apply Ice or Heat.

An ice pack, a package of frozen vegetables or an ice cup can relieve pain, swelling and inflammation.  A heating pad, electric blanket or warm bath/shower relaxes muscles.

Consider over-the-counter medications.  

Good options include pain relievers such as Acetaminophen (Tylenol and generic) or anti-inflammatory drugs such as ibuprofen (Advil and generic) and naproxen (Aleve and generic).

Sleep Comfortably.

Lying on your side with a pillow between your knees or on your back with a few pillows beneath your knees might help.

Talk with your doctor.

If symptoms don’t improve, consider seeing a doctor to make sure that the problem doesn’t stem from a serious underlying health problem.  If the pain is severe, ask about prescription pain relievers.