Getting an x-ray to uncover the source of lower back pain does not reduce suffering. In fact, in a new study, patients who had an x-ray, or radiography, reported more pain 3 months later than those who did not have an x-ray.

There is no evidence that having radiography helps doctors to care for people with simple back pain.

There is even evidence that the very act of having an x-ray can, perhaps by appearing to increase the perception of severity, delay recovery.

Low back pain is a common medical problem, and doctors often x-ray the lower spine to diagnose the cause of the pain. In most cases, however, x-ray results do little to change the treatment of back pain.

Most of the time, x-rays are performed to reassure patients or doctors.

Interestingly, even though x-rays did not appear to help relieve back pain, more than 80% of patients in both groups said they would choose to have an x-ray if they could.

By 9 months, most of the differences between the groups diminished, although having an x-ray still did not appear to provide any benefits, the report indicates. Patients in the x-ray group tended to be more satisfied with their care, however.

The findings highlight the need to let people know that x-rays are of little use to most people with low back pain.

Since so many people believe that radiography is an essential feature of the management of back pain, there is a need for a campaign to inform the public.

When doctors order an x-ray to investigate low back pain, patients may interpret the move as a sign that they really are unwell, so they may be more likely to report pain and to think that the pain interferes with their activities.

British Medical Journal February 17, 2001; 322: 400-405