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Lower back or leg pain? Waiting before imaging could save millions

If physicians follow the guidelines for patients with leg and lower back pain and wait before getting MRIs, it could save half a billion dollars a year.

After starting a new weightlifting regimen a few years ago, I injured my lower back. The pain was unbelievable: Getting out of bed or up from a chair was excruciating, and spasms prevented me from straightening up when I bent over.

More from inertia than any other reason, I neglected to visit a physician; I went about my routine, and within a week it was better. Within three weeks, the pain was gone entirely.

Turns out, I did exactly the right thing -- for me, and for U.S. health care costs. "The vast majority of the time, these problems will resolve on their own," said John Ratliff, MD, a professor of neurosurgery. "Less than 2% will require surgery."

Yet in a recent study, he and fellow researchers found that about a third of patients who show up in doctor's offices complaining of lower back or leg pain undergo imaging, usually an MRI, before the recommended month of waiting and before patients undergo physical therapy.

The price of these premature pictures? Over half a billion dollars annually, according to the analysis. The study appears in JAMA Network Open.

Ratliff and his colleagues mined data from nearly 2.5 million patients who visited U.S. doctors between 2008 and 2015 because of lower back or leg pain, one of the most common reasons for doctor visits. The cause of the pain is frequently a pulled muscle or ligament, conditions that typically fix themselves.

While various medical organizations recommend holding off on imaging before 30 days, the researchers found that 32% of patients received imaging before that time. And, although the organizations recommend patients try physical therapy first, 35% received imaging before undergoing any therapy.

"A lot of time, it's driven by patients," Ratliff said. "They think something's wrong, so they want an MRI. They want an answer right away. Another thing may be fear on the part of physicians. They worry they're missing something, such as an infection in the spine or a tumor. They think it's safe to get an MRI."

A bit of good news: The study found that physicians and patients are getting better at waiting: From 2008 to 2015, the percent of cases deviating from the recommendations dropped from 37% to 33%.

"The needle is moving with regards to imaging," Ratliff said, "but there are a lot of opportunities for improvement." He said that both patients and physicians can benefit from education about injuries, and that electronic health records can discourage early imaging.

"For a lot of these patients, the problems likely resolved soon after or even before they got an MRI," he said. "Holding off can save a lot of money."

Image by mohamed_hassan

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