Patients with low back pain believe they are getting 'good' care if there are sent for X-rays in spite of the fact that the X-ray does nothing to improve their condition.

This finding came from a study of 421 patients with back pain lasting, on average, 10 weeks. Referral for radiography was not associated with any reduction in pain nor any improvement in functioning or overall health status. Nevertheless, in this study, patients expressed greater satisfaction with their care if they had been X-rayed (BMJ, 2001; 322: 400-5).

Guidelines for managing back pain are not consistent in terms of recommending radiography for back pain. Given its ineffectiveness, and the link between x-rays and cancer, it seems that both GPs and patients need to be better educated about the appropriateness of X-rays for the diagnosis and treatment of back pain.

Back belts, worn by those whose work involves lifting heavy loads, are an ineffective way to prevent back pain and injury. Investigators from the National Institute for Occupational Safety and Health in the US studied more than 13,000 employees at retail stores where back belts were either voluntary or mandatory.

No reduction of back pain was found among back belt wearers compared with those who did not use the belts (JAMA, 2000; 284: 2727-32, 2780-1).