Review Question - QID 3308

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Low Back Pain - Introduction Imaging Radiographs QID: 3308 (OBQ10.215)

QID 3308 (Type "3308" in App Search)

A 29-year-old male reports a 2-day history of atraumatic low back pain. He denies constitutional symptoms. He denies any bowel or bladder difficulties and physical examination reveals full motor strength and sensation. No pathologic reflexes are detected. All of the following are appropriate at the initial visit EXCEPT?

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Limited oral analgesia

255/3713

Radiographs of lumbar spine

83%

3075/3713

Schedule outpatient follow-up visit within 4 weeks

158/3713

Early range of motion exercises

93/3713

Reassurance

110/3713

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A previously healthy patient with an acute onset of nontraumatic lower back pain does not need diagnostic imaging before proceeding with therapeutic treatment. This patient had no "red flags" during the history (recent trauma or constitutional symptoms), and physical examination was normal without focal neurologic deficits. The appropriate treatment for acute onset lower back pain is solely symptomatic treatment. Diagnostic imaging is not necessary unless the initial treatment is unsuccessful and symptoms are prolonged.

Miller et al found the use of radiographs can lead to better patient satisfaction but not better outcomes.

Chou et al peformed a metanalysis that also concluded that lumbar imaging without indication of serious underlying condition does not improve clinical outcomes.