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Studies: Frequent X-rays for back pain: much too early and unnecessary


Common ailments: X-rays for back pain mostly avoidable
Back pain has become a real common ailment. Every fifth legally insured person goes to the doctor at least once a year because of such complaints. As a new study now shows, X-rays are often taken there, which would not be necessary. Most images therefore do not improve diagnosis or treatment of back pain.

Many X-rays would be avoidable
The number of people who need to be treated for back pain continues to grow. As was recently reported, just under 37 million Germans went to see a doctor last year for musculoskeletal or connective tissue disorders. Many of the approximately six million images that are taken each year during visits to family doctors or specialists due to back pain are avoidable. This is the conclusion of the "Facts Check Back" study by the Bertelsmann Foundation.

One of the most unnecessary treatments
Many doctors first have their back pain patients X-rayed, because ultimately no bone damage should remain undetected as a possible cause. However, many such examinations are often unnecessary. Because the back itself is not always to blame for back pain.

X-rays do not help improve the diagnosis of back pain within the first six weeks, my doctor at the Swiss Society for General Internal Medicine (SGAIM) recently published a list of the most unnecessary treatments.

Seldom identify specific causes
This can also be seen in the current study by the Bertelsmann Foundation. More than two out of three people (69 percent) believe that the doctor finds the exact cause of the pain using X-rays, computed tomography (CT) and magnetic resonance imaging (MRI) images.

But: “Doctors can only determine a specific cause of the pain in a maximum of 15 percent of those affected. Most images therefore often do not improve the diagnosis or treatment of back pain, ”says a press release.

Excessive visits to the doctor
According to the experts, doctors often do not adjust the wrong expectations. In addition to an excessive number of visits to the doctor, this also leads to an unnecessarily large number of images. In 2015 alone, doctors had over six million X-rays, CT and MRI images taken from their backs.

“The imaging findings are often overrated. This leads to unnecessary further examinations and treatments, unsettling the patient and can even contribute to the chronification of the symptoms, ”said Prof. Dr. Jean-Francois Chenot from the University of Greifswald and medical expert for the fact check.

85 percent of back pain uncomplicated
In addition, imaging diagnostics are often premature. Accordingly, an image was arranged for every second affected person without having previously attempted conservative therapy, for example with painkillers or physiotherapy. But "85 percent of acute back pain is medically uncomplicated and not specific," reports the foundation.

Since back ailments are muscular in most cases, it is usually advised to preventively strengthen the back through exercise. If symptoms develop, special back pain exercises or heat therapy can help. Further tips for back pain: avoid or lose weight if necessary and exercise regularly.

Guidelines recommend physical activity
According to the Bertelsmann Foundation, medical guidelines for back pain without indications of dangerous courses (e.g. vertebral fractures or inflammation) recommend maintaining physical activities as much as possible, avoiding bed rest and not carrying out any imaging diagnostics. However, doctors often deviate from these scientific recommendations.

So 43 percent of those affected are recommended rest and protection. In addition, doctors often increase the feeling of sickness of those affected instead of calming them down. According to this, 47 percent of those affected are told that their backs are "broken" or "worn out".

“Doctors have to correct wrong knowledge and expectations of patients. This is the only way to meet your own requirements as trustworthy experts, ”explained Brigitte Mohn, Member of the Bertelsmann Stiftung Executive Board.

Back patients in Berlin and Bavaria go to the doctor more often
The study, for which the Institute for Applied Health Research evaluated the anonymized data of seven million people with statutory health insurance, showed clear regional differences.

According to the information, those with back pain in Berlin or Bavaria go to the doctor much more often than in Hamburg, Schleswig-Holstein and Rhineland-Palatinate. The number of treatment cases per 1,000 insured per year varies between 370 in Hamburg and 509 in Berlin.

It was also found that the regulations for X-ray, CT and MRI scans vary by up to 30 percent between the federal states. In some urban and rural districts, twice as many pictures are taken as elsewhere.

Talks have to be paid better
"The thorough physical examination and the personal conversation between doctor and patient must be given more weight again," said Mohn. This requires corrections in the medical remuneration system. Talks would have to be paid better in relation to technology-based studies.

International examples also show that there are ways to reduce unnecessary and in case of doubt harmful health recordings. For example, doctors in parts of Canada have not received any remuneration since 2012 if it turns out that pictures were taken, even though no dangerous course of back pain was discernible. And in the Netherlands, there are stricter restrictions on access to X-ray, CT and MRI equipment. (ad)

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Video: Podcast #32 Blowing up back pain B S with Cathryn Jakobson Ramin (September 2021).