Measure of the Month: Low Back Pain

This week, the KHC launched a project dedicated to healthcare affordability, in partnership with NRHI. The movement, called Affordable Care Together, is focused on health, price, and waste — the three drivers of affordable healthcare.

The KHC has long been a trusted partner in reporting healthcare quality performance data. But you can’t address quality without also looking at value. For the Measure of the Month in September, we are highlighting a measure of healthcare waste – Use of Imaging Studies for Low Back Pain.

Low back pain is among the most common causes of disability and lost productivity in the United States, and more than 80% of the population will experience low back pain in their lifetime. However, low back pain is usually not caused by something very serious. A very common cause of low back pain is strain of the muscles and ligaments. This type of low back pain is very common and usually gets better within a few days to a few weeks. Most people with low back pain don’t need to have imaging tests or visit a specialist, nor do they usually need surgery.

What is recommended care for Low Back Pain?

People 18-50 with low back pain should not receive an imaging study (an X-ray, CT scan, or MRI) within the first 28 days unless a “red flag,” which refers to a serious symptom or physical exam finding, is detected by their doctor. Here are some reasons why doctors are discouraged from recommending an imaging test too early in the process of your evaluation.

Imaging tests have some risks. X-rays and CT scans expose your body to radiation. Over time, repeated exposure to radiation may increase your chance of getting cancer. Having an X-ray series of your lower back gives you about as much radiation exposure as 65 chest X-rays. Having a CT scan of your lower back gives you about as much radiation exposure as 165 chest X-rays. Since MRIs use magnets rather than X-rays, there is no risk from radiation. However, having metal objects or implants in your body (such as pacemakers, artificial joints, screws, stents, plates or staples) can be a serious risk and interfere with the test.

For most cases of low back pain, an imaging test doesn’t give doctors much information that’s useful for diagnosis or treatment, because strain on muscles and ligaments do not show up on these tests.

Medical research shows people with low back pain who get imaging tests do not recover any better or faster than those who do not receive them.

Having an imaging test can lead to more care than you need — and expose you to more risks. Many things that show up on imaging tests are not serious and may not be the cause of your pain. However, once these things have been seen on a scan, there is a tendency to want to do something about it. Often, this results in more tests or procedures that can be harmful, such as back surgery.

How do we compare nationally?

The KHC has tracked the Use of Imaging Studies for Low Back Pain since 2007. Kentuckiana and Kentucky has not seen much improvement in appropriate testing for low back pain, and our region continues to lag behind nationally in its performance on this measure. In 2016, 55% percent of patients in the Kentuckiana region received appropriate testing, and just 51% percent of patients throughout the Commonwealth received appropriate testing, compared to national rates of 71% to 74%.

This data perhaps illuminates a gap in care for Kentucky and Southern Indiana patients that can be explored as part of Affordable Care Together.