Clinicians involved in the treatment of musculoskeletal pain pathologies are frequently looking for tools that can change the way tests are ordered, interpreted, and used to improve the care of their patients. Understanding when a test is necessary not only assists with determining a diagnosis, but it also improves patient satisfaction. 

“Not only are many procedures unnecessary, some are actually harmful and can lead to mistaken diagnosis or endless rounds of follow-up testing when nothing is wrong,” said David M. Glick, DC, DAAPM, CPE.

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He said that the medical community can enhance the use of common studies for pain diagnosis by the “better understanding of the clinical limitations as well as the significance of the results of such studies.”

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Dr. Glick spoke of Choosing Wisely, an initiative launched by the ABIM Foundation that aims to identify unnecessary medical treatments, during his presentation. To date, the initiative has identified hundreds of potentially unnecessary medical tests and treatments.

The most important tools for differential diagnosis include history, clinical examination, and clinician experience, he said. There are adverse factors affecting physical diagnosis: limitations of time, reliance upon technology, and lack of clinical experience.

The reliability or the clinical relevance of any diagnostic procedure is never 100%, he said. The studies themselves could be deficient in a particular clinical situation. 

Dr. Glick spoke of shortcomings of common studies and identified ways to address them in a clinical setting. For instance, research shows that approximately 50% of asymptomatic patients have pathologies present on magnetic resonance imaging (MRI).1 

“The reverse is also true. So just because a study is negative for pathology, does not mean that a patient’s pain should go untreated,” he cautioned. “On the other hand, that same information when combined with clinical examination findings can be quite defining of the underlying pathology, even when the MRI is negative. Being able to understand how to use this information in the clinical decision-making process can completely alter the potential clinical course, resulting in improved clinical outcomes.”

This article originally appeared on MPR