Opportunity for GPs to reflect on imaging for low back pain 

This week NPS MedicineWise will be sending out an MBS Practice Review report on low back pain imaging to over 30,000 GPs across Australia with individualised MBS referral data for lumbosacral X-rays and CT scans.

The Practice Review clarifies that early diagnostic imaging for low back pain presentations is recommended only if there is a clinical suspicion of a serious spinal pathology. In primary care, 90-95% of low back pain presentations are non-specific and do not require imaging.

“In 2015 back pain was the second leading cause of disease burden in Australia, and in 2017-18, one in six Australians reported having back problems,” says NPS MedicineWise medical advisor Dr Kate Annear.

“Imaging is commonly requested to aid in diagnosis and guide treatment strategies. However, acute non-specific low back pain is essentially a clinical diagnosis and for patients with this condition, imaging doesn’t change management.”

“Although patients may request imaging, they may not be aware of the harms that can result, such as anxiety from incidental findings and a greater risk of further investigations and potentially unneccessary surgical interventions,” she says.

Red flags for potential serious spinal pathologies that could require further investigation are highlighted in the Practice Review report along with communication tips and resources to help manage consumer beliefs and expectations around imaging for low back pain.

The inclusion of individualised MBS data aims to prompt GPs to reflect on their own imaging referral patterns.

“GPs have different cohorts of patients. The data included in the individualised MBS Practice Review should be considered in the context of each practitioner’s own patient cohort and individualised indications for investigation,” says Dr Annear.

Time spent reflecting on the data provided in the Practice Review is approved for 2 points under the RACGP CPD Program.

The practice review aligns with Choosing Wisely recommendations from five health professional bodies, including the Royal Australian and New Zealand College of Radiologists, that health professionals should not request imaging if there are no indicators of a serious cause for low back pain.

For more information see nps.org.au/mbs-lowbackpain2021.