Traction Not Beneficial for Low Back Pain
The use of traction to help treat low back pain has no benefit, despite its widespread use, a new review of studies has found.
"Traction was introduced before it was properly evaluated in high-quality randomized trials, and as an intervention is already part of usual practice," said lead author Judy M.A. Clarke, M.D. "It is hard to convince health care providers not to use it."
Clarke, of the Institute for Work and Health in Toronto, and his colleagues analyzed data from 24 studies that included 2,177 patients with low back pain. "Neither continuous nor intermittent traction by itself is more effective in improving pain, disability or work absence than placebo, sham or other treatments for patients ...." they found.
The review appears in the most recent issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
"These potential adverse effects of traction are known; however, serious side effects have not been reported," Clarke said, "and potential side effects don't seem to be a strong indication for not using traction."
"Lower back pain can be very frustrating to treat, so we have a tendency to hold on to any option," said Alfred Anderson, M.D., of the American Academy of Pain Management. "It does work in some patients, just like so a number of other therapies we use. It is an option.".
Traction has been used since ancient Greece to treat back pain, according to the Web site of the California Spine Institute.
Back pain is the most prevalent and one of the most expensive medical disorders in industrialized societies; low back pain disables 5.4 million Americans and costs at least $16 billion each year in medical expenses and lost time at work, according to the American Academy of Orthopedic Surgeons.
Other treatments for lower back pain include over-the-counter pain relievers, such as aspirin, acetaminophen and non-steroidal anti-inflammatory drugs for short-term pain. Depending on the severity and duration of lower back pain, patients are generally treated with a combination of over-the-counter pain relievers, prescription drugs, physical therapy, behavioral therapy and in some cases, surgery.
A variety of traction methods exist, but all involve the use of a harness, often weighted, worn consistently or intermittently to apply force to gradually stretch the skeletal structure into better alignment. The level of force and duration of treatment varies. Autotraction uses the body's own weight, instead of mechanical weights, to achieve alignment. According to the authors, the exact mechanism by which traction might be effective is unclear.
In the studies, patients included those with or without sciatica, pain emanating from the sciatic nerve, which runs from the pelvis through the hip and buttocks and down each leg.
The patients were treated with various types of traction with or without other treatment; no treatment; placebo; or other treatments but no traction for as little as two weeks or as long as one year. Back pain was classified as acute (lasting less than four weeks), subacute (four to 12 weeks) or chronic (more than 12 weeks).
After-treatment measurements included pain, improvement or recovery, functional status and ability to return to work. Traction was no more effective than placebo, no treatment at all, or in combination with other therapies. Autotraction, however, proved moderately more effective than other types of traction.
Side effects of traction were reported in six of the studies and included an increase in pain, surgery after traction, aggravation of neurological signs and self-reported "probably or definitely worse" pain after traction.
The Cochrane review notes that two of its coauthors were also authors of two included studies; they were not involved in quality assessment or data extraction for those studies.