Sunday, March 28, 2010

Decompression - Yeah right

Spine and DiscImage by planetc1 via Flickr

Marketplace, a Canadian Broadcasting Corp (CBC) investigative TV show did a piece on decompression for low back pain.  This news item might get a lot of people angry.  I figure those who get mad will mostly be those who own and market the "decompression" machines.  Some of my chiropractic colleagues might get mad because they might believe that the chiropractic profession is put in a bad light but really I don't think so.  There was no inference that the problem with decompression machines is a chiropractic problem, the news piece just looked at one chiropractor's offices.  In fact they note that the College of Chiropractors of Ontario (the regulatory board for chiropractors in ONT) after being notified by Marketplace, will be investigating the chiropractor in the news piece regarding his advertisements.

So what are these non-surgical decompression machines?  Well they are just low back traction devices that cost a lot of money, thus require lots of patients to make the expenditure worth the money for the doctor.  Big bills means big advertising.  It is not uncommon for one to see very large advertisements in local newspapers.  These ads often have lots of claims of great success rates.  There are also claims that these are NASA technology.  Well those claims don't hold water as Marketplace found.  In fact the Oregon Attorney General's office has ruled that neither of these claims are valid and can't be used in Oregon.  I guess it's too bad if you live elsewhere.  I live in Connecticut and regularly see these ads in my local paper.

The real problem here is that people suffering with back pain are vulnerable to believing the advertisements because they are desperate to get relief.  The ads make it sound so good.  Go to the office, get an exam (may be just a wallet exam) and then get relief from this device with NASA technology and an 86% success rate.  Seems too good to be true, and of course it is.

Are there people with low back pain for whom traction is helpful?  The answer is yes but it shouldn't take thousands of dollars and months of care.  Research (1, 2) is starting to identify those people for whom traction is the best option but a definitive answer hasn't bee found yet.

So what is a poor suffering person to do?  Well one needs to find the doctor who isn't quick ordering any treatment or isn't really a one trick pony.  That means one that doesn't do traction on everyone.  Or doesn't do spinal manipulation on every patient.  Or doesn't schedule surgery - first thing. Or doesn't say exercise is a must for everyone.  Really treatment needs to be individualized to the patient.  One method for doing that is to use what my colleague Dr. Donald Murphy of the Rhode Island Spine Center has published as the diagnosis-based clinical decision rule.(3, 4)  There is more research that needs to be conducted on this method but I think it's the best model for how to manage the patient with spinal pain and determine the appropriate treatment.

SMP

1.    Fritz JM, Lindsay W, Matheson JW, Brennan GP, Hunter SJ, Moffit SD, et al. Is there a subgroup of patients with low back pain likely to benefit from mechanical traction? Results of a randomized clinical trial and subgrouping analysis. Spine. 2007 Dec 15;32(26):E793-800.
2.    Raney NH, Petersen EJ, Smith TA, Cowan JE, Rendeiro DG, Deyle GD, et al. Development of a clinical prediction rule to identify patients with neck pain likely to benefit from cervical traction and exercise. Eur Spine J. 2009 Mar;18(3):382-91.
3.    Murphy DR, Hurwitz EL. A theoretical model for the development of a diagnosis-based clinical decision rule for the management of patients with spinal pain. BMC Musculoskelet Disord. 2007;8:75.
4.    Murphy DR, Hurwitz EL, Nelson CF. A diagnosis-based clinical decision rule for spinal pain part 2: review of the literature. Chiropr Osteopat. 2008;16:7.

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4 comments:

  1. Thanks Stephen - well written. Marketplace is typically a very biased show but managed to keep that in check,for the most part, for this piece. I work in the same city as the chiro in that story and his ads are everywhere. The problem is that the ads make decomp sound like a panacea for all back pain, when as you accurately point out, only a small (and as yet, undetermined) % of low back patients would benefit from this expensive treatment. Those who have them in their office of course view every patient as a canditdate (to pay for the machine, not necessarily benefit from the intervention itself).

    Cheers,

    Shawn

    www.researchreviewservice.com

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  2. Dear Dr. Perle-
    Thank-you for helping expose a significant problem in the treatment of low-back pain. I have even seen ads which say, "the only chiropractor who treats serious low-back pain." Ridiculous of course!
    Brett Carr, DC

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  3. Excellent topics, I like this. I found this online that, I know Arkansas Spinal Care Conway, AR their commitment to their patients has led them to using the DRX spinal decompression equipment for low back pain.
    chiropractor conway ar

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  4. I think the problem is that if we assume, as I shall, that these doctors really are committed to providing their patients' with the best care, it is unfortunate that they haven't really found out that maybe this isn't the best care. Often doctor's desire to do the best isn't balanced with adequate skill at finding what is the best. It appears that docs often fall victim to believing the company's marketing and not searching the literature one their own.

    SMP

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