Posts tagged ‘guidelines’

May 6, 2014

Oh! The Pain in my Back!

Low back pain by Harrygouvas via Wikimedia Commons Copyright Creative Commons Attribution-ShareAlike 3.0 Unported (CC BY-SA 3.0)Lower back pain is common. In fact, in the US it is a leading reason for a trip to see the doctor. There are many causes for back pain – some of them related to the spine and its components and others related to adjacent structures. Things like kidney stones and diverticulitis can present with back pain. There are also times when the source of back pain is never fully found.


When should you see your doctor and when is imaging for back pain appropriate?


The good thing about back pain is that the natural course for most is improvement of symptoms by around 4 weeks – whether you have specific treatment or not. If you have severe back pain, if it is associated with other symptoms like pain or nerve changes in one of your legs (numbness, burning sensation or tingling) or if symptoms are not improving, a visit to the doctor is in order.


There are published guidelines helping your healthcare provider decide if you will benefit from imaging of the spine. A careful history and physical are key.


Why not image everyone with back pain? Imaging the spine in the majority of us will show abnormalities – our discs (those cartilage cushions between the vertebral bodies) will begin to show changes as we get older. This is a natural age-related process related to being upright – the discs are only good for so many miles! The problem with imaging for back pain is we will often see abnormalities of the discs – some can even be large and impressive – but they do not always correlate with your symptoms. Imaging can lead to confusion and over-treatment, and for uncomplicated back pain will likely not affect how your back pain is managed.


When will imaging for back pain help most? Imaging is recommended for immediate evaluation of some patients with back pain with history or signs that might indicate a serious problem requiring immediate intervention. These include patients with history or signs that might make cancer (a RARE cause of back pain) more likely – things like a known cancer elsewhere in the body or significant weight loss. Signs that there might be an infection are important. Any symptoms that suggest there might be involvement of the nerves to the lower body may also warrant immediate imaging.


Imaging after a trial of physical therapy (usually after a 6 week period) may be indicated in patients who fail to show improvement or have worsening of symptoms. Imaging may also be performed if symptoms persist in patients with history of osteoporosis and concern for new fractures.


How do we image and which test do we pick? Those will be explored in our next post on back pain!


So, if you have low back pain remember that in the vast majority of patients, symptoms will get better – although it may take a few weeks. A visit to your doctor will help determine if imaging is needed and will help in the management of your pain.

Image Credit: Low back pain by Harrygouvas via Wikimedia Commons Copyright Creative CommonsAttribution-ShareAlike 3.0 Unported (CC BY-SA 3.0).

Diagnostic Imaging Centers blogs on regularly about women’s health and general radiology Visit our sites for more helpful information!

February 25, 2014

Task Force Guidelines on Aorta Screening in Smokers

Vincent Willem van Gogh (self portrait) Copyright Public Domain

Vincent Willem van Gogh (self portrait) Copyright Public Domain

This is a call to older male smokers. As a smoker you are at risk for many health issues. While heart and lung conditions are the more commonly known diseases for smokers, vascular diseases are another. Abdominal aortic aneurysm, or “AAA,” is yet another significant health issue that may be seen with higher frequency in smokers. An aneurysm is an abnormal ballooning or dilatation of a blood vessel. In this case, the aneurysm involves the aorta – the main artery carrying blood to the abdomen and lower body. As the aneurysm gets bigger, there is a risk of sudden death from rupture.

Recently the USPSTF, a task force that reviews guidelines and screening studies, came forward with a recommendation with the intention of saving lives. The Task Force has issued a recommendation for ultrasound screening of male smokers over the age of 65 for the presence of an abdominal aortic aneurysm. Further research is needed to determine the usefulness of the screening test both in women who smoke and in older male non-smokers.

Making use of the simple non-invasive technology of ultrasound, one-time screenings for men in the high risk category will help improve survival from complications of abdominal aortic aneurysm. For more on the recommendation, we recommend this resource.