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Senior citizens with back pain often get quick x-ray or MRI that may be a waste

Early imaging of those age 65-plus does not seem to improve the outcome

physician reviews x-ray with senior citizenMarch 18, 2015 – When you, or another other senior citizen, goes to the doctor complaining of back pain, it is not uncommon for the physician to recommend an x-ray or an MRI to get a better look at the spine. The doctor would be following an accepted procedure for an early imaging in hopes of a quick solution. A new study, however, finds seniors getting the early image have no better success than older adults who did not.

The older adults who had spine imaging within 6 weeks of a new primary care visit for back pain had pain and disability over the following year that was not different from similar patients who did not undergo early imaging, according to the study in the March 17 issue of JAMA.

 

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The researchers were led to this study because there have been many questions about when to image senior citizens with back pain. Many guidelines recommend that seniors undergo early imaging because of the higher prevalence of serious underlying conditions.  However, there has not been strong evidence to support this recommendation.

Adverse consequences of early imaging are more substantial among older people because the prevalence of incidental findings on spine imaging increases with age, which may lead to a cascade of subsequent interventions that increase costs without benefits, according to background information in the article.

Additionally, the fact that this service is usuaiiy covered by Medicare, possibly makes the decision for early imaging easier for the physician.

Jeffrey G. Jarvik, M.D., M.P.H., of the University of Washington, Seattle, and colleagues compared function and pain at the 12-month follow-up visit among older adults who received early imaging (within 6 weeks) with those who did not.

The study included 5,239 senior patients (65 years or older) with a new primary care visit for back pain in three U.S. health care systems, who did not have radiculopathy (a condition affecting the spinal nerve roots and spinal nerves).

Diagnostic imaging – plain films, computed tomography (CT), magnetic resonance imaging (MRI) - was of the lumbar or thoracic spine.

Among the patients studied, 1,174 had early radiographs and 349 had early MRI/CT. At 12 months, neither the early radiograph group nor the early MRI/CT group differed significantly from controls on measures of back or leg pain–related disability.

On the other hand, there were marked differences in 1-year resource use and costs. Estimated monetary differences in 1-year total payments (payer and patient contributions) were $1,380 higher for patients with early radiographs and $1,430 higher for patients with early MRI/CTs.

 “Among older adults with a new primary care visit for back pain, early imaging was not associated with better 1-year outcomes. The value of early diagnostic imaging in older adults for back pain without radiculopathy is uncertain.”

 

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