Back pain can be extremely debilitating often leading to impaired mobility and lower quality of life. Researchers led by Dr. Jeffrey G. Jarvik of the University of Washington Medical School in Seattle examined the likelihood that early imaging studies would improve the outcome of clinical treatments in adults aged 65 and older.
According to the report, guidelines specify that younger patients should wait 4 to 6 weeks before having imaging studies (e.g. CT or MRI scans or X-rays) performed, but older patients can have such studies done earlier. But do earlier studies improve the clinical results in these patients? Would an earlier diagnosis have a positive long-term effect on patients pain, mobility, or ability to do activities of daily living?
The investigators examined the results 1 year post-imaging among over 5200 older patients. Of these, nearly 1200 had early X-rays, while about 350 had early MRIs or CTs. Either the lumbar (lower back) or thoracic (chest) spine was examined.
Dr. Jarvik and colleagues had the patients complete disability questionnaires that asked about back and leg pain (including its severity and duration), and functional status.
When the investigators compared the patients responses to those of a control group, they found no significant differences in reports of disability. They concluded that it was not clear that early imaging in older adults provided any benefit in terms of lasting improvement of disability.
ACSH s Dr. Gilbert Ross commented This study strongly suggests that older patients with back pain should not be treated differently than younger patients both groups should wait the recommended 4 to 6 weeks after the onset of the problem before having imaging studies performed. Accurate diagnosis is not so important in MOST cases of non-focal lower back pain (pain without evidence of specific nerve impingement); watchful waiting is the best cure (tincture of time), unless of course there are focal neurological findings or intractable pain.