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Diagnostic Guideline for Sciatica and other Causes of Low Back Pain

Many of your coworkers and friends complain about all the x-rays, CT and MRI scans they’ve received … not to mention being zapped with x-rays at airport security!  But here you are, most likely about to get zapped to find out why your sciatica has been bothering you for the past few days. Will an x-ray, MRI or CT scan be absolutely necessary at this point in your painful condition?  Believe it or not, even if you have a herniated disc causing sciatica symptoms, you may not need any images at your initial physician’s visit!

Doctors from Emory University Hospital and Georgia Health Sciences University developed new guidelines for diagnostic imaging with individuals experiencing low back.  The guidelines recommend that low back pain patients be identified during their initial evaluation into one of three types:

  1. Those with possible spinal nerve compression, for example in cases with sciatica or spinal canal narrowing
  2. Those with a specific underlying cause such as a tumor or disease
  3. Those with general low back pain, possibly due to muscle strain

In the case of lumbar radiculopathy, or sciatica, the physician may have the patient go through a series of movement tests to determine if muscular strength or reflexes have been affected. Unless the pain is severe, or nerve damage is suspected, the physician will most likely hold off on diagnostic imaging and recommend over the counter pain medication like acetaminophen or ibuprofen, along with careful exercise for several weeks.  If the symptoms don’t improve or worsen, the physician will likely require x-rays or other diagnostic imaging to determine the next treatment course.  Often with sciatica, a herniated disc is the culprit for low back pain and symptoms will improve on their own with time and activity.

The guideline report, published in the October issue of the Journal of the American College of Radiology, indicates a purpose for the new guidelines is the improvement of  patient care by decreasing the inappropriate use of imaging, prescription medication and unnecessary procedures that are medically invasive.  Any development in the forefront of health care that improves the patient’s well being and adheres to following conservative approaches to treatment when possible, is always a welcome bit of news.

Originally Posted on October 11, 2012
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