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Publication Briefs

Article Discusses the Overuse of Diagnostic Imaging for Chronic Low Back Pain

Low back pain is very common, and many patients receive routine spinal imaging (e.g., CT or MRI), despite evidence-based recommendations to the contrary. For example, one survey showed that 40% of family practice and 13% of internal medicine physicians reported ordering routine diagnostic imaging for acute low back pain. This is problematic because routine imaging does not seem to improve clinical outcomes and exposes patients to unnecessary harms. The overuse of imaging also contributes to the high and growing costs associated with low back pain. This article discusses evidence-based recommendations for the use of imaging tests in patients with low back pain, factors that promote the overuse of imaging, as well as how physicians can reduce overuse.


  • The American College of Physicians (ACP) and the American Pain Society (APS) call for imaging only for patients with low back pain who have severe or progressive neurologic deficits – or signs or symptoms that suggest a serious or specific underlying condition.
  • Patient expectations and preferences about diagnostic testing can affect clinical decisions, e.g., wanting diagnostic testing is a frequent reason for repeated office visits for chronic back pain.
  • The number of MRI scanners in the U.S. tripled from 2000 to 2005, and in 2006 there were nearly as many MRI machines in western Pennsylvania as in all of Canada. Studies suggest that greater availability of imaging resources correlates with their increased use.
  • To be most effective, efforts to reduce the use of diagnostic imaging should be multi-focal and should address clinician behaviors, patient expectations, and financial incentives.


  • The authors suggest that implementation of the ACP/APS recommendations on judicious and selective low back imaging would improve patient care while reducing costs.

Dr. Owens is part of HSR&D’s Center for Health Care Evaluation in Palo Alto, CA; Dr. Shekelle is part of the VA Greater Los Angeles Healthcare System.

PubMed Logo Chou R, Qaseem A, Owens DK, and Shekelle P. Diagnostic Imaging for Low Back Pain: Advice for High-Value Health Care from the American College of Physicians. Annals of Internal Medicine February 1, 2011;154(3):181-189.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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