Health care utilization and pain outcomes following early imaging for low back pain in older adults

Adam C. Powell, Teresa L. Rogstad, Sarah W. Elliott, Stephen E. Price, James W. Long, Uday U. Deshmukh, M. Hassan Murad, Mark W. Steffen

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Professional societies have provided inconsistent guidance regarding whether older patients should receive early imaging for low back pain, in the absence of clinical indications. The study assesses the implications of early imaging by evaluating its association with downstream utilization in an elderly population. Methods: Patients were included if they had a Medicare Advantage plan, had claims-based evidence of low back pain in 2014, and lacked conditions justifying early imaging. The outcomes examined were short-term, nonchronic, and chronic opioid use, steroid injections, and spinal surgery in the following 730 days, and persistent low back pain at 180 to 365 days. Morphine dose equivalents of opioid use was used as a measure of intensity. Logistic and γ regressions were used to assess the association between imaging in the first 6 weeks and the outcomes. Results: Among the 57,293 patients meeting inclusion criteria, the mean age was 71.2, and 26,606 (46.4%) received early imaging. Early imaging was associated with increased adjusted odds of short-term (odds ratio [OR], 1.21; 95% CI, 1.15 to 1.28), nonchronic (OR, 1.78; 95% CI, 1.69 to 1.88), and chronic (OR, 1.13; 95% CI, 1.07 to 1.18) opioid use, as well as steroid injections (OR, 2.55; 95% CI, 2.28 to 2.85) and spinal surgery (OR, 3.40; 95% CI, 2.97 to 3.90). Patients that received early imaging were more likely to experience persistent pain (OR, 1.09; 95% CI, 1.05 to 1.14) and used significantly more morphine dose equivalents if they had nonchronic opioid use. Conclusions: Early imaging for low back pain in older individuals was common, and was associated with greater utilization of downstream services and persistent pain.

Original languageEnglish (US)
Pages (from-to)773-780
Number of pages8
JournalJournal of the American Board of Family Medicine
Issue number6
StatePublished - Dec 2019


  • Diagnostic Imaging
  • Evidence-Based Medicine
  • Geriatrics
  • Low Back Pain
  • Medicare
  • Opioids
  • Outcomes Research
  • Pain Management
  • Radiology

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Family Practice


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