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Approximately 2.5 million Americans visit outpatient clinical settings for low back pain each year. Approximately 75% of adults will experience low back pain at some time in their lives. In any three-month period, approximately 25% of Americans will experience at least one day of back pain.


Evidence shows that unnecessary or routine imaging (X-ray, MRI, CT scans) for low back pain is not associated with improved outcomes. It also exposes patients to unnecessary harms such as radiation and further unnecessary treatment. For the majority of individuals who experience severe low back pain, pain improves within the first two weeks of onset.


Avoiding imaging for patients when there is no indication of an underlying condition can prevent unnecessary harm and unintended consequences to patients and can reduce health care costs.


Joint guidelines from the American College of Physicians (ACP) and the American Pain Society state that clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain and should reserve imaging for patients with severe or progressive neurologic deficits or when serious underlying conditions are suspected on the basis of history and physical examination.


Potential red flags to consider earlier imaging are easily remembered by an acronym: TUNA FISH.


T     Trauma or tuberculosis

U     Unexplained loss of weight

N     Neurological deficits, bowel and bladder incontinence

A     Age < 20 and ≥ 55


F     Fever

I      Intravenous drug use

S     Steroid use or immunosuppressed

H    History of cancer


If you have any questions about this communication, call Provider Services at 1‑800‑901‑0020 or Anthem CCC Plus Provider Services at 1‑855‑323‑4687.



1 Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians Ann Intern Med. 2017; 166(7):514-530


2 Use of Imaging Studies for Low Back Pain (LBP) HEDIS Measures and Technical Resources.



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March 2020 Anthem Provider News - Virginia