American Society of Anesthesiologists – Pain Medicine
View all recommendations from this societyReleased January 21, 2014
Avoid imaging studies (MRI, CT or X-rays) for acute low back pain without specific indications.
Imaging for low back pain in the first six weeks after pain begins should be avoided in the absence of specific clinical indications (e.g., history of cancer with potential metastases, known aortic aneurysm, progressive neurologic deficit, etc.). Most low back pain does not need imaging and doing so may reveal incidental findings that divert attention and increase the risk of having unhelpful surgery.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
The American Society of Anesthesiologists (ASA) Committee on Pain Medicine was charged with developing the “Top 5 List” on pain medicine for the Choosing Wisely® campaign. Committee members submitted potential recommendations for the campaign, and from this list voted on which recommendations should be included in the final “Top 5 List.” The literature was then searched to provide supporting evidence. The Committee communicated electronically and met in person during the development and approval process. Once approved by the Committee, the “Top 5 List” was reviewed by ASA’s Chair of the Section on Subspecialties, Vice President for Scientific Affairs, Executive Committee and Administrative Council. ASA’s “Top 5 List” for pain medicine has been endorsed by the American Pain Society.
ASA’s disclosure and conflict of interest policy can be found at www.asahq.org.
Sources
Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009;373(9662):463–72.
Chou R, Qaseem A, Snow V, Casey D, Cross JT, Shekelle P, Owens DK; Clinical Efficacy Assessment Subcommittee of the American College of Physicians; American College of Physicians; American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147(7):478–91.
Davis PC, Wippold FJ, Brunberg JA, Cornelius RS, De La Paz RL, Dormont PD, Gray L, Jordan JE, Mukherji SK, Seidenwurm DJ, Turski PA, Zimmerman RD, Sloan MA.ACR appropriateness criteria on low back pain. J Am Coll Radiol. 2009;6(6):401–7.
Kendrick D, Fielding K, Bentley E, Miller P, Kerslake R, Pringle M. The role of radiography in primary care patients with low back pain of at least 6 weeks duration:a randomized (unblended) controlled trial. Health Technol Assess. 2001;5(30):1–69.
Miller P, Kendrick D, Bentley E, Fielding K. Cost-effectiveness of lumbar spine radiography in primary care patients with low back pain. Spine. 2002;27(20):2291–7.
