It’s estimated that 75 to 85 percent of Americans will experience some type of lower back pain during their lifetime.¹ To assist in diagnosing the severity of a patient complaint of lower back pain, providers often order imaging tests such as X-rays, magnetic resonance imaging (MRI), and computerized tomography (CT) scans. However, imaging tests do not provide useful information in cases of strained muscles and ligaments, expose patients to unnecessary radiation, and may not be cost effective.

The Healthcare Effectiveness Data and Information Set (HEDIS^®)^* defines the measure for Imaging Studies for Low Back Pain as the percentage of patients with a primary diagnosis of low back pain who did not have an imaging study (X-ray, MRI, or CT scan) within 28 days of diagnosis. The measure is an inverted rate, meaning that a higher score indicates appropriate treatment of low back pain.²

Imaging for low back pain often not associated with improved outcomes

Evidence shows that X-rays, MRIs, and CT scans for low back pain are often unnecessary and not associated with improved outcomes. For many individuals who experience severe low back pain:

• Pain improves within the first two weeks of onset
• The avoidance of imaging can prevent unnecessary harm and unintended consequences, as well as reduce health care costs, when there is no indication of an underlying condition³
• Imaging is not recommended within the first six weeks unless red flags are present⁴

Imaging alternatives⁵

According to our HEDIS data collected by Cigna Healthcare^℠, there has been an increased trend in imaging studies for patients diagnosed with low back pain. There are alternative treatment options we encourage you to consider first before imaging. They include:

• Exercises to strengthen the low back and core
• Physical therapy
• Nonsteroidal anti-inflammatory drugs
• Nonpharmacologic treatment such as massage and heat or ice

¹ American Association of Neurological Surgeons. Lower Back Pain: American Association of Neurological Surgeons.

² Retrieved from https://www.NCQA.org/wp-content/uploads/HEDIS-MY-2024-Measure-Description.pdf. 

³ Use of Imaging Studies for Low Back Pain. NCQA. Retrieved from https://www.NCQA.org/hedis/measures/use-of-imaging-studies-for-low-back-pain. 

⁴ Imaging for Low Back Pain. American Academy of Family Physicians (AAFP). Retrieved from https://www.aafp.org/family-physician/patient-care/clinical-recommendations/all-clinical-recommendations/cw-back-pain.html.  

⁵ Amir Qaseem, MD, PhD, MHA, et al. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. 04 April 2017. Retrieved from https://www.acpjournals.org/doi/10.7326/M16-2367.

*HEDIS^® is a registered trademark of the National Committee for Quality Assurance (NCQA).