Week 1- Overtreating Low Back Pain

Question 1

Economic cost of LBP

Answer 1

100-200 billion in lost wages and productivity

Question 2

What is the #1 reason for prescription of opioids?

Answer 2

LBP

Question 3

What percent increase did spinal fusions see from 1998-2011?

Answer 3

113%

Question 4

Common lumbar MRI findings in pain-free individuals

Answer 4

• 50-66% of asymptomatic subjects have disc bulges
• 30% of pain-free subjects show herniated discs
• 90% of pain-free subjects show degenerative disc disease
• Case of grade IV spondylolisthesis w/ no pain or disability

Question 5

What is imaging appropriate for?

Answer 5

• Pt w/ LBP when severe or progressive neurologic deficits are present
• Serious underlying conditions are suspected based on Hx and physical exam
• Potential candidates for surgery or epidural steroid injection

Question 6

Risks of CT & MRI

Answer 6

• Increased risk of cancer (~1200 from 2.2 million scans)

- Higher rates of surgical intervention