Low back pain: Can we mitigate the inadvertent psycho-behavioural harms of spinal imaging?

ABSTRACT

BACKGROUND: Low back pain is responsible for significant personal and societal burden, particularly when it becomes persistent. Despite international consensus regarding the judicious use of diagnostic spinal imaging, patients continue to be over-referred. OBJECTIVE: The aim of this article is to highlight the critical need for primary care clinicians to engage in thoughtful use of imaging procedures, and to consider alternative or adjunct methods for providing reassurance, in order to avoid or mitigate the potential negative impact of 'anomalous' findings. DISCUSSION: While imaging is frequently requested with the goal of reassuring patients, it can paradoxically have a negative impact on patient attitudes and beliefs and can influence pain behaviours. For improved patient outcomes we recommend contextualisation of radiological findings within age-related norms, use of reassuring and non­threatening language when communicating results, and educating patients on non­pathoanatomical contributors to pain.