Doctors' Choice Physical Medicine

Back Pain Recommendations… Four to Question

The following four back pain recommendations are from the North American Spine Society.

Back Pain Recommendations: Do not have advanced imaging (e.g., MRI) of the spine within the first six weeks if you only have non-specific acute low back pain in the absence of red flags.

(Red flags are identifying signs that would indicate an imaging test should be performed.  There are not many patients that come to our office that have a Red Flag.)

MRI Scan

In the absence of red flags, advanced imaging within the first six weeks has not been found to improve outcomes, but does increase costs. Red flags include, but are not limited to: trauma history, unintentional weight loss, immunosuppression, history of cancer, intravenous drug use, steroid use, osteoporosis, age > 50, focal neurologic deficit and progression of symptoms. These days it is almost impossible to get a authorization from an insurance company for a MRI before 6 weeks of conservative care (chiropractic, physical therapy, and decompression).  Therefore, if your doctor is recommending an MRI with conservative treatment first you have to ask him/her why.

Back Pain Recommendations: Don’t have spinal injections without imaging guidance, unless contraindicated.

Epidural: only an option for one sided leg pain

Elective spinal injections, such as epidural steroid injections, should be performed under imaging guidance using fluoroscopy or CT with contrast enhancement (unless contraindicated) to ensure correct placement of the needle and to maximize diagnostic accuracy and therapeutic efficacy. Failure to use appropriate imaging may result in inappropriate placement of the medication, thereby decreasing the efficacy of the procedure and increasing the need for additional care. Epidurals are only indicated for one sided leg pain as an option to avoid surgery.  Other uses for them, such as just low back pain is not recommended.  Epidurals can relieve pain, but there is no long term therapeutic value.  In other words, they don’t fix the pain causing problem.  Additionally, epidurals should only be performed if conservative care (physical therapy, chiropractic, and decompresson) have failed.  If your doctor is not recommending conservative care first ask him/her why.  You should do the conservative treatments that have the greatest effectiveness first, don’t skip them.  They also have the highest patient satisfaction rating.

Back Pain Recommendations: Don’t have an electromyography (EMG) and nerve conduction studies (NCS) to determine the cause of just back and neck pain. 

There has to be symptoms in the extremities for these tests to have value. Electromyography and nerve conduction studies are measures of nerve and muscle function. They may be indicated when there is concern for a neurologic injury or disorder, such as the presence of leg or arm pain, numbness or weakness associated with compression of a spinal nerve. As spinal nerve injury is not a cause of neck, mid back or low back pain, EMG/NCS have not been found to be helpful in diagnosing the underlying causes of only lumbar, thoracic and cervical spine pain. So if your doctor wants to do and EMG/NCV test and you only have back or neck pain ask why.  There may be exam findings that warrant the test, but make sure it is more than just back or neck pain.

Back Pain Recommendations: Don’t use bed rest for more than 48 hours for low back pain.

In patients with low back pain, bed rest exceeding 48 hours in duration has not been shown to be of benefit.

Back Pain… What To Do

All back pain treatment should start with conservative therapy, like chiropractic or physical therapy.  they cost the least, studies show they are most cost effective, and they have the highest patient satisfaction scores.

Here are some other articles that may interest you.

To find our more about spinal decompression treatment, click here.

Underlying causes of back pain, click here.

Back pain causes, click here.

American Medical Association’s back pain treatment recommendation, click here.

MedX low back pain testing and exercise, click here.