The use and diagnostic yield of radiology in subjects with longstanding musculos

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The use and diagnostic yield of radiology in subjects with

longstanding musculoskeletal pain - an eight year follow up

Hans Lindgren and Stefan Bergman

BMC Musculoskeletal Disorders 2005

http://www.biomedcentral.com/1471-2474/6/53/abstract

Published 3 November 2005

Abstract (provisional)

Background

Longstanding musculoskeletal pain is common in the general population

and associated with frequent use of health care. Plain radiography is

a common diagnostic approach in these patients despite knowledge that

the use in the investigation of musculoskeletal pain is associated

with low diagnostic yield, substantial costs and high radiation

exposure. The aim of this study was to assess the use of diagnostic

imaging and the proportion of pathological findings with regard to

duration and distribution of pain in a cohort from the general

population.

Methods

An eight-year longitudinal study based on questionnaires at three

occasions and medical records on radiological examinations done in

medical care. Thirty subjects were selected from an established

population based cohort of 2425 subjects that in 1995 answered a

postal survey on pain experience. At baseline there were ten subjects

from each of three pain groups; No chronic pain, Chronic regional

pain, and Chronic widespread pain (CWP). Those who presented with CWP

at two or all three occasions were considered to have a longstanding

or re-occurring CWP. In total the thirty subjects underwent 102

radiological examinations during the eight year follow up.

Results

There was a non-significant (p=0.10) finding indicating that subjects

with chronic pain at baseline (regional or widespread) were examined

three times more often than those with no chronic pain. When the

indication for the examination was pain, there was a low proportion

of positive findings in subjects with longstanding CWP, compared to

all others (5.3% vs 28.9%; p=0.045). On the other hand, in

examinations on other indications than pain the proportion of

positive findings was high in the CWP group (62.5% vs 14.8%; p=0.001).

Conclusions

Radiological examinations had a low diagnostic yield in evaluation of

pain in subjects with longstanding/reoccurring CWP. These subjects

had on the other hand more often positive findings when examined on

other indications than pain. This may indicate that subjects with

longstanding/reoccurring CWP are more prone to other diseases. It is

a challenge for caregivers, often primary care physicians, to use

radiological examinations to the best for their patients.