People with back pain don’t always need imaging

Dr. Debra Johnston

People with back pain don’t always need imaging

Experts estimate that well more than 80% of people will experience back pain at some point in their lives.

Perhaps 10% of adults experience it at any given moment.

Back pain is extremely common, and people with back pain can be extremely miserable. It may hurt to move, sit, stand, lay, even breathe. No wonder back pain accounts for so many visits to the doctor.

When people with acute back pain come to see me, they often have a preconceived notion of what will happen. They anticipate I will talk with them, examine them and many expect X-rays or an MRI. They are often surprised, and sometimes worried, when I stop short of ordering imaging.

My first goal when I see someone with acute back pain is to rule out rare conditions that threaten life and limb. Could this be a fracture? Cancer? Infection in the bone or spinal cord? Severe and rapidly progressing compression of the nerves? These conditions could require imaging for diagnosis and urgent treatment. However, they are uncommon, and unless specific red flags are revealed during the patient history and exam, it is extremely unlikely a rare condition is responsible for the pain.