11 September 2017

Take 6: Managing low back pain

Clinical Pain

What is the place of radiological imaging when investigating low back pain?

This topic can often be a source of anxiety for GPs, says Dr Charlotte Johnstone, a pain medicine specialist and anaesthetist at the Royal Prince Alfred Hospital and Lifehouse.

“I think [for] someone who presents the first time with low back pain, you probably don’t need to do much in the way of radiological investigation,” she says.

“Certainly, treating them with Pilates and physiotherapy is going to be a big step in terms of managing their pain.

“I would suggest to you if they have some good treatment over a couple of months with Pilates or a physiotherapist and they are not getting better, I think you should go back to the drawing board.”

Getting an MRI is not easy in general practice, according to Dr Johnstone. GPs would have to be thinking about some very specific reasons to be doing it, she says.

“And the specific reasons would be if they have sensory loss, motor weakness and especially changes below the knee.

“Also, if they have bowel or bladder changes that you might be concerned about in terms of spinal canal stenosis.

“If their back pain is also associated with pain that is … deep in the pelvis, that doesn’t fit a normal pattern of back pain and those are the things I would be worried about in terms of nerve damage or cancer and I would get an MRI in those circumstances.”

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2 Comments on "Take 6: Managing low back pain"

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Matt Barber
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2 months 6 days ago

Why would I be treating with pilates? The evidence is much stronger for yoga than it is for pilates.

Getting MRIs in general practice isn’t actually very hard. I work in a very low SES and patients aren’t troubled by paying for this investigation if we think it’s important.

In most situations it isn’t necessary, of course.

Glenn Rosendahl
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Glenn Rosendahl
2 months 10 days ago
But if the presenting symptoms and signs (at the beginning) included… …sensory loss, motor weakness and especially changes below the knee. Bowel or bladder changes (that you might be concerned about in terms of spinal canal stenosis), or pain that is … deep in the pelvis, that doesn’t fit a normal pattern of back pain… Would you treat ‘over a couple of months with Pilates or a physiotherapist’ BEFORE considering an MRI? I would like to think that a physiotherapist would alert you to their concern, but ultimately it is your (the GPs) responsibility to find that malignancy or that… Read more »
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