Don’t routinely prescribe imaging for low back pain without warning signs or symptoms (Red Flags)

Type of practice


Low back pain is usually benign and self-limiting. The history and physical examination, inclusive of neurological assessment, can exclude serious clinical situations. Imaging in low back pain without Red Flags is in generally inappropriate (at least for the first 6 weeks), because it doesn’t modify the therapeutic approach. Inappropriate imaging can also be dangerous both for patients (ionizing exposition) and community for the waste of money in unnecessary tests. Incidental findings can induce anxiety and promote a vicious circle of unnecessary tests.


1. Low back pain. Early management of persistent non-specific low back pain. Nice Clinical Guideline 88, 2009.
2. Negrini S et al. Diagnostic-therapeutic flow-charts for low back pain patients: the Italian Clinical Guidelines. Eura Medicophys. 2006; 42(2): 151-70.
3. Giovannoni S, Minozzi S, Negrini S. Percorsi diagnostico-terapeutici per l’assistenza ai pazienti con mal di schiena. Pacini Ed, 2006.
4. Chou R et al. Imaging strategies for low back pain: systematic review and metanalisis. Lancet 2009; 373: 463-72.
5. Srinivas S, Deyo R, Berger Z. Application of “Less Is More” to Low Back Pain. Arch Intern Med 2012; 172(13): 1016-20.

Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.