Immediate imaging with X-rays, CT scans, or MRIs for patients with acute low back pain is not recommended for all patients, according to new guidelines by the American College of Physicians.

• Imaging tests are appropriate for people with low back pain that may be due to cancer, infection, nerve damage or pain that worsens despite initial treatment.

• Signs of these more serious conditions include weight loss, fever, loss of muscle strength, and/or sensation in the legs and abnormal reflexes in addition to the low back pain.
• Unnecessary imaging exposes patients to preventable harms, may lead to additional unnecessary interventions, and results in unnecessary cost.
• Every patient feels their workup isn’t complete without an MRI but it doesn’t change anything.
• If someone has a history of cancer, and there is a reason to suspect that cancer has spread to the spine, or there is nerve damage an MRI will help determine whether or not surgery is needed.
• Before insisting on an MRI, see someone who specializes in diagnosing and treating back pain.
• Seeing a back pain specialist such as a physiatrist can help reduce unnecessary imaging tests and subsequent spinal surgeries by as much as one-third.
• Imaging is over utilized, but the more patients are educated, the more these tests will be ordered appropriately.

http://www.webmd.com/back-pain/news/20110131/skip-the-mri-for-low-back-pain