If you develop any new symptoms like weakness in your legs, numbness or pain down the leg you should call me. Let’s try this treatment and I will see you back in 6 weeks. “There are things we can do to help your symptoms to help you feel better. An MRI is the gold standard but the problem is that even in healthy patients we see abnormal discus so we are never sure that the finding on the MRI are related to your symptoms. A CT scan is not particularly helpful and exposes you to a lot more radiation. I do not think you need a plain x-ray as they show us the boney problem which is unlikely to be the problem. “I want to be sure you are comfortable with this plan. “I want to reassure you that your symptoms are very different from those of your brother or someone with a herniated disc”įinding common ground and understanding patient perspective and barriers will help reach agreement and provide patient satisfaction and hopefully improve patient health outcomes. “I certainly understand that you want to get better?” Make it clear that you are on the patient’s side (provide empathy and partnership) Patients are more satisfied and are more likely to adhere to recommendations if they feel understood, supported, and a sense of partnership with their physicians. Provide Empathy, Partnership, Legitimation.“What do you think is going on and what are you worried about? “Is there anything you are concerned about? “ “You look concerned do have any questions for me?” Understanding patients’ treatment goals and perspectives about their health during the visit will help improve patient satisfaction and can shorten visits.įind out where the patient is coming from “I would not recommend an x-ray at this point given these findings and the fact that except for having pain in the back from muscle spasm your examination is normal.” “The good news is that based on your history and your normal physical examination I do not think that you need an x-ray.” The majority of patients want information about their health, illness and decision options. In general, imaging should be saved for patients for whom noninvasive, conservative regimens have failed and surgery or therapeutic injection are being considered. (7) The imaging of the lumbar spine before 6 weeks does not improve outcomes, but it does increase costs. (12)Ī meta-analysis by Chou et al found no clinically significant difference in patient outcomes between those who had immediate lumbar imaging versus usual care. (11) A study by Jarvik et al showed that patients with low back pain who had an MRI were more than twice as likely to undergo surgery compared with patients who had plain film imaging. (9) A study by Webster et al showed that patients with occupation-related back pain who had early magnetic resonance imaging (MRI) had an eightfold increased risk of surgery. (10) In addition studies have linked the increase rate of imaging with the increase rate of surgery. (9) The labeling phenomenon of patients with low back pain has been studied and shown to worsen patients’ sense of well-being. (8) Risks associated with routine imaging include unnecessary radiation exposure and patient labeling. Studies have shown that patients with no back pain often show anatomic abnormalities on imaging. In the absence of progressive neurologic deficits or other red flags, there is strong evidence to avoid CT/MRI imaging in patients with non-specific low back pain. (5) The majority of disc herniations will regress or reabsorb within eight weeks of onset. Most patients with radicular symptoms will recover within several weeks of onset. Fractures are an uncommon cause of back pain they are associated with risk factors such as osteoporosis and steroid use. It is also important to rule out nonspinal causes of back pain, such as pyelonephritis, pancreatitis, penetrating ulcer disease or other gastrointestinal causes, and pelvic disease. The evaluation for low back pain should include a complete, focused medical history looking for red flags, which include, but are not limited to: severe or progressive neurologic deficits (e.g., bowel or bladder function), fever, sudden back pain with spinal tenderness, trauma, and indications of a serious underlying condition (e.g., osteomyelitis, malignancy). Low back pain is one of the most common reasons for an outpatient visit. Sources: Agency for Health Care Research and Policy (AHCPR), Cochrane Reviews Supporting Information Imaging of the lower spine before six weeks does not improve outcomes, but does increase costs. Low back pain is the fifth most common reason for all physician visits. (Red flags include, but are not limited to, severe or progressive neurological deficits or when serious underlying conditions such as osteomyelitis are suspected.) Don't do imaging for low back pain within the first six weeks, unless red flags are present.
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