Getting Rid of That Aching Back
Avoiding the Knife
"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."