Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Low Back Pain Table 1. Red Flags: Indications of a more complicated status include back pain/radiculopathy in the following settings (adapted from Bigos et al [8]). Previous guidelines have suggested that imaging be performed in adults >50 years of age who present with LBP. When studied, there was no statistically significant difference in primary outcome after 1 year for patients aged 65 years or older who had spine imaging within 6 weeks after an initial visit for care for LBP versus similar patients who did not undergo early imaging [9]; thus, this document does not include >50 years of age as an independent red flag. However, an important age-related risk factor for spinal fracture presenting as LBP is osteoporosis. As bone mass decreases slowly over time, the prevalence of osteoporosis increases with age, and differs by sex, race, ethnicity [10], and comorbidities. In line with the US Preventive Services Task Force recommendations for patients ages 65 and older being screened for osteoporosis, patients >65 years of age may be considered at risk for osteoporotic fracture when presenting with LBP. Additionally, for those patients without neurologic compromise and who present with minor risk factors for cancer, inflammatory back disease (eg, ankylosing spondylitis), vertebral compression fracture, or symptomatic spinal stenosis, imaging should be considered after a trial of therapy [4]. In the majority of patients, no specific pathology for LBP can be identified. Also, studies have shown imaging abnormalities in a substantial number of people without back pain [11-13].
Low Back Pain PCAs. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Low Back Pain Table 1. Red Flags: Indications of a more complicated status include back pain/radiculopathy in the following settings (adapted from Bigos et al [8]). Previous guidelines have suggested that imaging be performed in adults >50 years of age who present with LBP. When studied, there was no statistically significant difference in primary outcome after 1 year for patients aged 65 years or older who had spine imaging within 6 weeks after an initial visit for care for LBP versus similar patients who did not undergo early imaging [9]; thus, this document does not include >50 years of age as an independent red flag. However, an important age-related risk factor for spinal fracture presenting as LBP is osteoporosis. As bone mass decreases slowly over time, the prevalence of osteoporosis increases with age, and differs by sex, race, ethnicity [10], and comorbidities. In line with the US Preventive Services Task Force recommendations for patients ages 65 and older being screened for osteoporosis, patients >65 years of age may be considered at risk for osteoporotic fracture when presenting with LBP. Additionally, for those patients without neurologic compromise and who present with minor risk factors for cancer, inflammatory back disease (eg, ankylosing spondylitis), vertebral compression fracture, or symptomatic spinal stenosis, imaging should be considered after a trial of therapy [4]. In the majority of patients, no specific pathology for LBP can be identified. Also, studies have shown imaging abnormalities in a substantial number of people without back pain [11-13].