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15-09-2013 | Pain medicine | Article

Traction for lower back pain ‘not supported by evidence’

Abstract

Free abstract

medwireNews: Traction does not improve lower back pain or its associated functional and psychosocial outcomes, report the authors of a systematic review.

The Cochrane Back Group concludes that neither manual nor mechanical traction are proven effective treatments for lower back pain, with or without sciatica. Furthermore, they note that some studies found traction to carry a risk for unwanted effects such as increased pain or aggravation of neurologic signs.

“To date, the use of traction as treatment for non-specific [lower back pain] cannot be motivated by the best available evidence,” state Inge Wegner (University Medical Center Utrecht, the Netherlands) and fellow authors of the Cochrane Back Group.

Wegner’s team sought to update a Cochrane review first published in 1995 and previously updated in 2006. Their literature search yielded 32 randomized controlled trials. lasting from 1 week to 1 year, involving 2762 patients with acute, subacute, or chronic lower back pain.

Numerous interventions were evaluated across the trials, including various forms of traction (auto-traction versus manual or passive traction, continuous versus intermittent traction, inversion versus conventional traction), traction versus physiotherapy, physiotherapy alone, sham traction, placebo (sham shortwave diathermy), underwater therapy, and no treatment.

Traction was found to be worse than the comparator in some studies and equivalent in others. A handful of studies found that traction was superior to the comparator, but the benefits were statistically non-significant and/or transient.

Of the seven studies that reported adverse effects, traction was associated with increased pain, anxiety, an increased risk for surgery, and aggravation of neurologic signs and symptoms.

Writing in the Cochrane Database of Systematic Reviews, Wegner et al conclude that traction “probably has no impact on pain intensity, functional status or global improvement” in patients with lower back pain and sciatica. However, they warn that their conclusion is based on trials of very low-to-moderate quality and that “none of the findings should be considered robust.”

“Only new, large, high-quality studies may change the point estimate and its accuracy, but it should be noted that such change may not necessarily favor traction,” they write. “Therefore, little priority should be given to new studies on the effect of traction treatment alone or as part of a package.”

medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013

By Joanna Lyford, Senior medwireNews Reporter