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Practice Change

Do not routinely offer imaging for uncomplicated low back pain

BMJ 2021; 372 doi: (Published 12 February 2021) Cite this as: BMJ 2021;372:n291

Rapid Response:

Re: Do not routinely offer imaging for uncomplicated low back pain

Dear Editor,

I agree with my Foot & Ankle Surgeon colleague. "Sprained ankle" is not a diagnosis, it is a Presenting Complaint (PC). It is where the history, examination and investigations begin, not where they finish.

Recent years in medicine have seen a sustained 'anti-diagnosis' attack on musculoskeletal medicine with the introduction of nebulous terms such as 'Non-specific lower back pain (NSLBP)' and now even 'non-specific shoulder pain'.

In reality, there are many diagnosable causes of lower back pain. With careful history, examination, imaging and diagnostic blocks, a definitive diagnosis can be made in the majority of patients.

The average time to diagnosis for someone with Ankylosing Spondylitis, for example, is often many years. These patients are robbed of many Quality-adjusted life years (QALYs), due to a cursory diagnosis of NSLBP. The same is true for many other back pain conditions.

There is also the issue of untreated acute LBP becoming chronic due to lack of diagnosis and treatment. This leads to long-term disability, under-employment and excess mortality.

Competing interests: No competing interests

22 February 2021
Leon C Creaney
Consultant in Sport & Exercise Medicine
Manchester Institute of Health & Performance
299 Alan Turing Way, Manchester