The scientific evidence says "no".
Back pain is a highly prevalent disorder and studies have reported over 90% of all adults will experience some type of back pain in their lifetime. It is the second most common reason for people to visit their primary care physicians. Although most episodes of low back pain are self-limited, there are some patients who develop chronic back pain which is legitimate and unresponsive to available medical treatment protocols.
As a result of chronic low back pain, patients are often interested in alternative measures to reduce their pain. One example of this is the often advertised use of the Decompression, Reduction and Stabilization (or DRS) spinal decompression therapy. The DRS is expensive and upfront, non-refundable payment in full is typically required before treatment begins. As a result of multiple questions from patients regarding these devices, I was compelled to determine if there is science to support the many claims made in the media.
Lumbar traction can be provided manually by a therapist or by mechanical devices. Examples of mechanical traction devices include the previously mentioned DRS, along with Accu-Spina, SpineMED, and VAX-D to name a few. The amount of marketing associated with these devices is quite extensive, and there are many claims with regard to success in the treatment of back pain. However, these claims of success are not supported by randomized controlled studies published in the medical literature.
Review of published studies of traction as a treatment for low back pain demonstrate poor study design and lack of evidence supporting benefit. A 2007 update of the Cochrane Collaboration reviewed 25 randomized controlled trials and concluded that intermittent or continuous traction as a single treatment for low back pain cannot be recommended with low back pain with or without sciatica. In the studies reviewed there was strong evidence of no statistically significant difference in outcomes between traction, placebo, or no treatment at all. The Agency for Health Care Research and Quality has concluded that there is insufficient medical evidence to support the efficacy of decompression therapy and treatment for chronic back pain when compared to other nonsurgical treatment options.
Review of the medical policy from Blue Cross/Blue Shield states “based upon our criteria and review of the peer review literature, lumbar traction by any method has not been medically proven to be affective and is considered investigational”. Medicare and most other insurance companies maintain the same policy with regard to the use of the mechanical traction, regardless of the type of device utilized. The Washington Department of Labor and Industries has published two technology assessments of power traction devices used for intervertebral decompression. Both reports concluded that published literature had not demonstrated that such devices are more effective than other forms of traction, other conservative treatments, or surgery. A similar conclusion was provided by the Australian evidence based practice group.
It is one thing to claim in an infomercial that a procedure works, and it is another thing to actually prove it based upon scientific studies. Before you invest your money (don’t expect insurance to pay), ask yourself why Lutheran, St. Joe, and Parkview Hospitals don’t own these devices. They can certainly afford them. Ask yourself why nearly every insurance company considers it investigational. The reason, there is no proven benefit.
Mark V. Reecer, MD
Fort Wayne Physical Medicine, PC
Board Certified Physical Medicine
Board Certified Pain Medicine
Posted in: General