Interpretation of radiography of the spine in low back pain
Dear Sir
INTERPRETATION OF RADIOGRAPHY OF THE SPINE IN LOW BACK PAIN
Kendrick et al (1) set out to demonstrate that radiography of the
lumbar spine is not associated with improved clinical outcomes or
satisfaction with care. They conclude that it confers no benefit and
indeed patients who have been investigated report a longer duration of
pain, more severe pain, reduced functioning and overall poorer health
status. They conclude radiography reinforces patients’ beliefs that they
are sick. I would agree with this conclusion but feel that the added
morbidity may be explained at least in part by the way that the
radiography report is interpreted.
However, many patients referred to the Pain Management Clinic with low
back pain have been told by their General Practitioner that radiography
shows that they have ‘arthritis in their spine’, ‘narrowed disc spaces’, a
‘crumbling spine’, ‘bulging discs’, ‘degenerative disc disease’, ‘wear and
tear’ etc. I suspect that this labelling of the patient with a ‘negative
medical diagnosis’ for their simple low back pain after having radiography
contributes greatly to the increase in reported symptoms and development
of chronicity in these patients. I feel that Kendrick et al slightly
missed the point and in their conclusion should have highlighted the
negative effect that primary care interpretation of the radiography has on
low back pain.
Keith A. Milligan
Clinical Director
Pain Management Clinic,
South Cleveland Hospital,
Middlesbrough
TS4 3BW
Rapid Response:
Interpretation of radiography of the spine in low back pain
Dear Sir
INTERPRETATION OF RADIOGRAPHY OF THE SPINE IN LOW BACK PAIN
Kendrick et al (1) set out to demonstrate that radiography of the
lumbar spine is not associated with improved clinical outcomes or
satisfaction with care. They conclude that it confers no benefit and
indeed patients who have been investigated report a longer duration of
pain, more severe pain, reduced functioning and overall poorer health
status. They conclude radiography reinforces patients’ beliefs that they
are sick. I would agree with this conclusion but feel that the added
morbidity may be explained at least in part by the way that the
radiography report is interpreted.
However, many patients referred to the Pain Management Clinic with low
back pain have been told by their General Practitioner that radiography
shows that they have ‘arthritis in their spine’, ‘narrowed disc spaces’, a
‘crumbling spine’, ‘bulging discs’, ‘degenerative disc disease’, ‘wear and
tear’ etc. I suspect that this labelling of the patient with a ‘negative
medical diagnosis’ for their simple low back pain after having radiography
contributes greatly to the increase in reported symptoms and development
of chronicity in these patients. I feel that Kendrick et al slightly
missed the point and in their conclusion should have highlighted the
negative effect that primary care interpretation of the radiography has on
low back pain.
Keith A. Milligan
Clinical Director
Pain Management Clinic,
South Cleveland Hospital,
Middlesbrough
TS4 3BW
doctor@kamilligan.freeserve.co.uk
1. Kendrick D. et al. Radiography of the lumbar spine in primary care
patients with low back pain: randomised controlled trial. BMJ 2001;322:400
-5
Competing interests: No competing interests