Judicious usage of radiological imaging
Injudicious radiological imaging is expensive while it may not yield any clinical benefit. For example, an MRI scan would cost up to one third of average monthly household income in Nepal . Likewise, MRI scanning on patients with early stage of non-specific low back pain is likely to encourage surgeries, consequently incurring greater costs of care, increased usage of prescribed opioids, and increased intensity of pain during follow-up sessions . The MRI and ultrasound tend to establish causal relationship between structural abnormalities and symptoms, leading to medicalising normality and necessitating unwarranted interventions on normal age-related changes that are unrelated to the symptoms .
Conversely, a review of high-quality clinical guidelines recommends imaging only if (i) serious pathologies such as infection, malignancy, fracture, inflammatory cause of pain, progressive neurological deficits including cauda equina syndrome, and serious pathology mimicking musculoskeletal pain such as aortic aneurysm are suspected; (ii) unsatisfactory response to exhaustive and evidence-based conservative management and unexplained progressions of signs and symptoms are observed; and (iii) imaging will likely change the management .