Abstract
Low back pain (LBP) has a prevalence of 84% in Africa. The commonest form of imaging is plain lumbar spine x-ray. It gives a radiation dose equivalent to 65 times a chest x-ray dose and sends one of the highest doses to the human reproductive organs. The commonest cause of LBP in Africa is degenerative disease. X-ray findings do not change mode of treatment yet most physicians still routinely request for x-rays. This is a systematic review of databases including The Cochrane, CINAHL plus, AMED, and MEDLINE. Key evidence was clinical guidelines on x-ray use for low back pain. Key search terms included low back pain, x-rays, guidelines, Ghana. Four clinical guidelines on LBP emerged from two Systematic Reviews rated excellent and four good Randomized Controlled Trials: The European guidelines for acute and sub-acute non-specific Low Back Pain, The American College of Physicians and the American Pain Society guideline for diagnostic imaging for Low Back Pain, The NICE guidelines for persistent non-specific Low Back Pain and the Ghana Standard Treatment Guidelines (GSTG). All the guidelines agree that a good history and clinical examination for all LBP patients helps in diagnosing. Only GSTG recommends routine plain spinal x-rays. There is strong evidence indicating very little benefit from routine lumbar spine x-rays for all LBP. The GSTG needs to be revised considering the increased risks of radiation exposure and the x-ray costs. None declared.
Highlights
Low back pain is the commonest musculoskeletal condition accounting for 30-40% of visits to rheumatologists in sub – Saharan Africa.[1]
Four guidelines on back pain emerged from the search with three of them being based in developed countries and one from Ghana, a developing country
The guidelines that emerged from the search included; the European guideline for acute and sub-acute nonspecific low back pain[14], the American College of physicians and the American Pain Society guideline for diagnostic imaging for low back pain,[15] the United Kingdom’s (UK) National Institute for Clinical Excellence (NICE) guidelines for persistent non-specific low back pain16and the Ghana Standard Treatment (GST) guidelines.[17]
Summary
Low back pain is the commonest musculoskeletal condition accounting for 30-40% of visits to rheumatologists in sub – Saharan Africa.[1] The lifetime prevalence of low back pain is known to be 84% worldwide causing disability in 11-12% of the world’s population.[2] It ranks sixth among the DALYs (disability adjusted life years) causing diseases and injuries.[3] research initially concluded that the prevalence of low back pain was higher in developed countries, a systematic review of low back pain in Africa revealed a prevalence comparable to that of developed countries.[4]. Low back pain is usually grouped as specific, having a suspected pathological cause, and non-specific, having an unknown cause It can be classified as acute – lasting less than 6 weeks, sub-acute – lasting between 6weeks and 12 weeks and chronic- lasting more than 12 weeks.[5]
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