News

Early x ray for low back pain confers little benefit

Annabel Ferriman, BMJ

Routine early x ray examination for low back pain is expensive and confers little benefit, a new report from the Health Technology Assessment programme said last week.

The report describes and analyses the first randomised controlled trial based in UK general practice to have looked at whether a GP referral for radiography affects short and long term outcomes for patients who consult with low back pain.

The trial, which involved 153 patients from 94 GP practices in London, showed few significant differences at six weeks or one year between patients who were referred for lumbar radiography of the spine and those who were not.

The team, which carried out the research from the department of general practice and primary care at St George's Hospital Medical School, London, said that referral for x ray examination led to a small improvement in patients' psychological wellbeing over the next 12 months. It made no difference, however, to physical outcomes, further consultation rates, or referrals to other health professionals.

An observational study of 506 patients carried out at the same time showed similar results, though patients referred for x ray examination in the observational study were more likely to consult again within six weeks and to continue to consult after six weeks.

Earlier research showed that patients who were told that they had degenerative joint disease expressed greater satisfaction with their care and were less likely to seek alternative care than patients with similar x ray results who were not given a diagnosis, the report says.

Although guidelines from the Royal College of Radiologists recommend that GPs should wait 6-8 weeks before referring patients for radiographyand then only if the symptoms are not resolvingthe report estimates that about half the referrals for radiography do not conform to guidelines.

No one knows how many x ray examinations for back pain are carried out each year, but a study run by the Clinical Standards Advisory Group in 1994 found that about 270 patients were referred annually per 10000 population. Such a referral rate today would mean that more than a million such examinations were carried out in England and Wales each year, at a cost of about £42m ($59m).

The report concludes that existing guidelines are sound and that early radiography is not indicated, though it might still be considered when anxiety is a major feature.

The report is available at www.ncchta.org