When do I need an imaging test for my back pain?
Ask the doctor
Q. I suddenly developed low back pain for the first time. My doctor said I didn’t need an x-ray or other imaging test. Is that typical?
A. Yes, your doctor is following current guidelines. Unless you have other symptoms or risk factors for a serious condition, an x-ray, CT scan, or MRI is unlikely to be helpful. Besides being costly, imaging tests can also yield “false positive” results, in which an abnormality is detected but turns out to be harmless.
However, there are exceptions. Someone with back pain who also exhibits specific “red flag” symptoms should undergo an imaging test immediately. For example:
- A fever may signal an infection.
- Severe pain or pain that wakes you up at night could indicate a more serious problem.
- Back pain after an injury may indicate a fracture.
- Leg weakness or an inability to control bladder or bowel function may be a sign of spinal cord compression.
Otherwise, take a common-sense approach to treating new back pain. Rest may be necessary for a day or two, but remain as active as possible. To help ease discomfort, use a heating pad or cold compresses and, if needed, a low-dose over-the-counter pain reliever. If the pain worsens or persists for more than a few weeks, let your doctor know.
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About the Author
Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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