A research paper titled, “Health Care Utilization and Pain Outcomes Following Early Imaging for Low Back Pain in Older Adults” has been published online by the Journal of the American Board of Family Medicine. This study explored the association between early imaging and downstream utilization in a Medicare Advantage population in order to bring additional attention to the lack of clarity which surrounds whether older individuals should receive early imaging for new onset low back pain.
Patients were included in the analysis if they had a Medicare Advantage plan, had claims-based evidence of low back pain, and lacked conditions justifying early imaging. The outcomes examined were short-term, non-chronic, and chronic opioid use, steroid injections, and spinal surgery in the following 730 days, and persistent low back pain at 180-365 days. Morphine Dose Equivalents (MDEs) of opioid use was used as a measure of intensity. Logistic and Gamma regressions were used to assess the association between imaging in the first six weeks and the outcomes.
A total of 57,293 patients were included in the study. Early imaging was associated with increased odds of short-term (OR 1.21; 95% CI: 1.15-1.28), non-chronic (OR 1.78; 95% CI: 1.69-1.88) and chronic (OR 1.13; 95% CI: 1.07-1.18) opioid use, as well as steroid injections (OR 2.55; 95% CI: 2.28-2.85) and spinal surgery (OR 3.40 95% CI: 2.97-3.90). Patients that received early imaging were more likely to experience persistent pain (OR 1.09; 95% CI: 1.05-1.14) and used significantly more MDEs if they had non-chronic opioid use.
The study concluded that early imaging for low back pain in older individuals was associated with greater utilization of downstream services, but was not associated with less likelihood of persistent pain. In response to the study’s findings, the study’s lead author, Adam C. Powell, Ph.D., remarked, “The Choosing Wisely initiative has highlighted the need to carefully consider imaging shortly after the onset of low back pain. That said, there is inconsistency between guidelines as to whether advanced age should be considered as a factor warranting early imaging. Researchers at HealthHelp, in collaboration with colleagues at Humana and the Mayo Clinic, have worked together towards providing additional insights into this critical question.”
To read this study in its entirety, please click here: https://www.jabfm.org/content/32/6/773