Reviewed by Dr. Craig H. Kliger
April 2, 2001 -- Eric Taylor suffered from back pain for almost 30 years. He tried physical therapy, pain relievers, anti-inflammatory medicines, and surgery, but nothing worked. His doctor told him he could have steel rods placed in his spine or put up with the pain for the rest of his life.
Taylor sought an alternative. A friend told him about a new procedure called vertebral axial decompression (VAX-D) that might relieve pain without surgery. Taylor thought, why not?
"As long as it was nonsurgical and noninvasive, I was open to it," says Taylor, a 54-year-old attorney in St. Louis. "I was ready."
Nearly 70% of all people will suffer from low-back pain at some point in their lives, according to the CDC. It is the most common work-related injury, the Occupational Safety and Health Administration (OSHA) reports. There is little, however, that can be done. Bed rest is the most prescribed remedy, followed by exercise, muscle relaxants, pain medication, physical therapy, chiropractic intervention, and surgery. These and other methods often fail to provide long-term relief. But researchers say there is new hope: The VAX-D therapeutic table.
Approved by the FDA in 1996, the device was designed by Allan E. Dyer, MD, PhD, a former Canadian deputy health minister who helped develop the heart defibrillator. Treatment using the table is said to relieve lower back pain by applying tension to the spinal column to decompress the intervertebral discs.
A study published in April 1998 in The Journal of Neurological Research found that VAX-D is effective in relieving pain in 71% of cases. The majority of the 778 patients -- cases reviewed from 22 centers across the country -- reported a reduction in pain to a level of 0 or 1 on a 0 to 5 scale (with 5 being the highest level of pain). About 1% of patients reported an increase in pain, while 7% experienced no change. About 4% of the patients had had previous lumbar disc surgery. The researchers suggest that postsurgical patients who still have persistent pain should try VAX-D before considering further surgery.
"This table has been shown to have a significant benefit for patients," says William Naguszewski, MD, co-author of the nonrandomized study (meaning patients were not randomly assigned to other treatments for purposes of comparison), conducted in conjunction with researchers from the University of Illinois at Chicago and the Coosa Medical Group in Rome, Ga. "When the patient completes the treatment, they are back on their feet and walking and working the rest of the day."
The table's use, however, is controversial, and insurers generally do not cover it. "Since there are really no clinical, randomized trials on this, there is really no way of gauging whether it has any advantage over standardized, conventional treatment," says Matthew Schiffgens, spokesman for Kaiser Permanente.
Others, too, call for further proof. "Seventy percent of people with backache get better no matter what you do," says Kenneth Smith Jr., MD, director of neurosurgery at Saint Louis University. "A 70% success rate would not be at all surprising, or all that wonderful."
Smith says VAX-D is similar to traction, but is a "newer, fancier machine that costs a lot more." He considers the therapy investigational, but he says it could help some people with whom other treatments have failed.
Aetna U.S. Healthcare agrees that the Naguszewski study results appear promising but says controlled clinical trials are needed to validate the table's effectiveness. The insurer takes the same position as the federal Health Care Financing Administration (HCFA). "There is insufficient scientific data to support the benefits of this technique," HCFA states in its Medicare coverage manual.
Most patients in the study had suffered through 40 months of back pain and had tried a variety of conventional remedies before VAX-D, says Naguszewski, a neurologist who practices in Rome, Ga. People have been slow to accept the treatment, he says, simply because it's new.
"There is a negative bias regarding the introduction of a new therapeutic modality in general in this country," says Naguszewski, who has treated more than 300 patients with VAX-D since 1996. "Oftentimes this is valid, but a lot of patients are not fully informed of the potential benefits of VAX-D are not familiar with the treatment, and surgeons have a surgical bias."
Candidates for VAX-D include those with herniated discs, degenerated discs, and sciatica, among others. More than 1,000 patients are treated with VAX-D therapy each month, according to the VAX-D Network, a group that promotes the treatment, which is available in 26 states.
Treatment usually consists of 20 daily sessions that last about 30 minutes each. Patients lie fully dressed on the table on their bellies with a pelvic harness strapped around their hips. Tension is applied through the harness as the table, which is divided into two sections, moves apart. The therapy is administered through a computerized system that applies tension followed by periods of rest. Handgrips held with elbows straight allow the patient to release the tension at any point.
"This gives the patient a lot of peace of mind because if they have any concerns, simply letting go stops the forces of traction," Naguszewski says.
Each VAX-D session costs about $150. After therapy has been completed, Naguszewski still recommends lifting no more than 50 pounds and avoiding repetitive bending, stooping, or crawling for several weeks.
Taylor says he started to feel some relief after about 40 sessions and six weeks of therapy. The numbness in his foot and thigh has disappeared. He doesn't water ski anymore, which started his back pain in the first place, and still receives treatments once a week. But he does swim, walk, ride his Harley, and can work 70-hour weeks.
"I live a normal, active life. We go to the movies. We go to parties. We got to restaurants and drive all over the country. Other than not being able to engage in active or high-impact sports, I live a full life," he says.
"Without VAX-D, I don't know where I'd be. I would probably have a bunch of steel in my spine and probably be stuck in bed someplace. I was headed there real fast."