and Medicine for Seniors
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
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.
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
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
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 painrelated 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
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.