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09/02/2009
Scans
are less useful to back injury sufferers than you may
believe
According to a recent study by US scientists,
back pain sufferers may gain very little from
undergoing clinical investigations such as MRI or CT
scans. The research suggests that back pain patients
rarely see any benefit from the scans and with a
constantly adjusting spine, traditional methods of
treatment may still be the best.
UK
studies have also previously supported this view.
The
study comes at a time when the medical profession awaits
a serious review and update of the treatment guidelines
to be issued by the
National Institute for Clinical excellence (NICE)
expected in May 2009.
The
US study looked at pain, function, quality of life,
mental health, overall patient-reported improvement and
patient satisfaction in the care they received for up to
a year after their initial treatment. All the patients
were randomised to receive either immediate scans or
standard clinical care. Some of the standard care group
were offered scans if they had not improved within three
weeks. They did not find significant differences between
immediate imaging with X-ray or MRI scans and usual
clinical care either in the short-term - up to three
months later, or the long-term - six to 12 months.
When handling
no win
no fee compensation claims it is now quite common to
arrange for investigative scans when traditional methods
of treatment have failed. Many
whiplash claim
solicitors will press for such scans on the
recommendation of the medico-legal doctor.
The NICE existing guidelines suggest treatment
should proceed as follows:
-
Consider course of manual therapy
-
Consider course of acupuncture
-
Consider structured exercise programme
- Do
not offer an X-ray
- MRI
only for suspected spinal fusion or other serious
underlying condition
It is
estimated that more than 40% to 50% of the population in
the UK experience back pain in any given year. The
majority will "recover" substantively within six weeks.
The
draft guidelines from NICE say X-ray and MRI
investigations of the spine should be limited to when
tumours, breaks, fusions or serious inflammation and
infection is suspected. It advises all people with lower
back pain to exercise, if necessary in supervised
groups, and that doctors should be able to offer a
course of manual therapy or acupuncture.
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