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Low Back Pain Imaging Guidelines From the Desk of Dr. Sara Liter-Kuester Please refer to these Red Flag guidelines as a reminder of appropriate use of imaging for Low Back Pain. More information is available in the Low Back Pain Management Kit available from Mercy Physician Community PHO. AMERICAN COLLEGE OF RADIOLOGY GUIDELINES FOR LOW BACK PAIN - DIAGNOSTIC IMAGING VARIANT 1 Uncomplicated acute low back pain and/or radiculopathy (no red flags) RECOMMENDED PROCEDURE ALTERNATIVE PROCEDURES •No imaging recommended *The vast majority of patients with uncomplicated LBP (low back pain) return to their usual activities within 30 days. Indications or “red flags” of a more complicated status may warrant the following imaging procedures: 2 Low velocity trauma, osteoporosis, and/or Age >70 yrs. •MRI lumbar spine without contrast •CT lumbar spine without contrast •X-ray lumbar spine •MRI lumbar spine without and with contrast •CT lumbar spine without contrast if MRI is contraindicated •X-ray lumbar spine •MRI lumbar spine without contrast •CT lumbar spine without contrast •MRI lumbar spine with contrast if noncontrast MRI is indeterminate •MRI lumbar spine without and with contrast •CT lumbar spine without contrast if MRI is contraindicated •MRI lumbar spine without contrast 3 Suspicion of cancer,infection or immune-suppression 4 Low back pain and/or radiculopathy > 6 weeks, surgery or inter-vention candidate 5 Prior lumbar surgery 6 Cauda equine syndrome •MRI lumbar spine without contrast •MRI lumbar spine without and with contrast •Myelography and post-myelography CT lumbar spine Along with the guidelines for diagnostic imaging, here are some treatment tips for acute low back pain. PHARMACEUTICAL TREATMENT •Prescribe OTC oral analgesics on a time contingent basis not pain cotingent basis. Acetaminophen is recommended for its few side effects. NSAIDS including ibuprophen and enteric coated aspirin are second line agents due to potential for gastric irritation. NON PHARMACEUTICAL TREATMENT •Limit bed rest beyond 2 days •Encourage low stress aerobic activity (walking, swimming, stationary biking) and gradual stretching as tolerated as well as avoidance of activities that cause back irritation. •Apply cold (ice packs) initially for 1-2 days followed by heat applications. Manipulation may be helpful in the first month of treatment. PATIENT EDUCATION •Encourage positive expectation of recovery •Teach safe and effective methods of symptom control, activity modification and strengthening back exercises.