VAX-D: Treating Back Pain Without Surgery
Experts discuss the effectiveness of a back pain treatment that offers an alternative to surgery.
The Issue of Safety continued...
As for the potential to experience pain, Dyer says: "The patient participates by holding hand grips. The patient can always let go, a natural reaction if pain is experienced."
The clinician also plays an important role. "With good clinicians, patients do not experience shoulder pain," Dyer tells WebMD. "The practitioner needs to be a good clinical observer."
Can patients suffer injuries during VAX-D treatment? Current literature from the VAX-D manufacturer states that "not one single injury has been sustained by a patient." A published report in a 2003 issue of Mayo Clinical Proceedings disputes that statement. The report describes a severe complication suffered by a patient during VAX-D treatment. The authors describe a "sudden, severe exacerbation of radicular pain" during a treatment session. Images of the subject's lumbar region showed significant enlargement of the disk protrusion after VAX-D, requiring emergency surgery. To date, this is the only published report of an adverse effect caused by VAX-D.
How Effective Is It?
Does VAX-D really work? To date, anecdotes such as that reported by Reiner and others offer the most persuasive evidence in favor of VAX-D's effectiveness. But what do studies tell us about VAX-D?
"There are some studies suggesting that VAX-D is effective. Most people would say they're fairly flawed. The studies out there are not high quality," says Daniel J. Mazanec, MD, a spine specialist with the Cleveland Clinic. Lack of controls and the use of "sham treatments" (or placebo) for controls demonstrate poor quality of existing studies, he explains.
For instance, a study on VAX-D published in a 1998 issue of Neurological Research reported a 71% success rate among the 778 subjects who underwent VAX-D treatment. While these results sound promising, the weakness of the study design dampens them. The study's glaring problem? It contained no control group. Investigators did not compare the effectiveness of VAX-D against subjects who received no treatment, placebo treatment, or some other type of treatment.
While Mazanec does not perform VAX-D in his practice, some of his patients received it elsewhere before coming to him. "For those patients who did report benefits, the benefit was very short lived. Or, they were simultaneously given oral steroids [to treat] sciatica, making it hard to determine what improved the pain," Mazanec tells WebMD.
Would he be willing to try it on his patients? "There need to be better studies before I would be comfortable believing that it's an effective part of a treatment regimen," Mazanec says.
Other clinicians who do incorporate VAX-D into their practice report favorable results.
Such is the case with Philippe Chemaly, DO, MPH, a physiatrist. He uses VAX-D on patients as part of a comprehensive treatment approach rather than a singular solution to back pain. "With VAX-D, there is no substitution for good physical therapy. Physical therapy teaches you techniques to do at home, which I think add to your long-term outcomes," he tells WebMD.