Decline in Opioid Consumption Maintains Consistent Level of X-Ray Usage
In a recent study, visits to U.S. emergency departments (EDs) for low back pain remained common, with one in every 20 emergency visits during the six-year period (2016-2022) being related to low back pain. Despite a significant decrease in opioid prescribing for low back pain from 32.5% in 2016 to 13.5% in 2022, the use of imaging, particularly X-rays, has remained stable at 36-43% of visits.
The average pain score reported during low back pain visits was 7.2 out of 10. Most low back pain patients during the study period were non-Hispanic White and women. However, the study did not provide any information on the demographic distribution of emergency department visits for low back pain during the study period.
The decision to order X-rays is complex, influenced by both clinician judgment and patient expectations or pressure. Recent clinical guidelines recommend selective imaging use for low back pain, but consistent application remains challenging. There is room to improve practice to better align imaging with guidelines to avoid unnecessary tests.
While opioid prescriptions for low back pain have decreased due to growing awareness of opioid risks, imaging use remains steady because of diagnostic complexity, the need to exclude serious conditions, patient-clinician dynamics, and challenges in guideline implementation. Studies support that appropriate imaging referral guidelines safely exclude significant injury and improve care quality, suggesting that education and decision support could reduce unnecessary imaging without compromising patient outcomes.
However, the study did not address the effectiveness of the preferred non-opioid treatments for low back pain in reducing the need for imaging tests. The study authors noted that while opioids can sometimes be appropriate for severe pain, they carry risks, and other treatments are often preferred as first steps. MRI scans were performed in a little more than 3% of low back pain cases, and CT scans were done in just over 5% of cases.
Older patients (aged 75 and above) were more likely to receive opioids and have imaging tests than younger patients for low back pain. The study did not find a significant decrease in the use of imaging tests (X-rays, CT scans, MRI scans) in low back pain cases. The authors of the study suggested that education and guideline awareness may not have had as strong an impact in the area of imaging use.
The study did not discuss any specific non-opioid treatments that are preferred as first steps for low back pain. The overall data presented a mixed picture, with fewer opioids being prescribed but continued reliance on imaging. Efforts to integrate imaging referral criteria and decision support systems are critical to optimizing imaging use for low back pain in emergency care.
- To optimize health-and-wellness outcomes for individuals experiencing low back pain, it's essential to increase understanding and implementation of selective imaging guidelines that can exclude serious medical-conditions and reduce unnecessary tests.
- Fitness-and-exercise programs, in addition to non-opioid treatment options, could potentially decrease the need for imaging tests in low back pain cases by managing pain effectively and improving overall well-being.
