A Controlled Study Of Spinal Decompression And Tens For Treatment Of Low Back Pain

Several studies have been completed and reported on the success rates of the treatment of Chronic Low Back Pain using the mechanized Spinal Decompression machine. One study recently appeared in May 2007 in Chiropractic and Osteopathy. It compared success rates from the use of a non-surgical intermittent mechanized traction machine with the use of TENS in relieving low back pain due to a herniated or bulging disc.

First, to understand any study, you need a picture of the disorder and the chronic misery it causes. Back pain due to an injury or accident is the leading Workmen’s Comp injury and the main reason for disability in people under 45. The spinal column is made up vertebrae stacked one on top of another. Between each vertebra is a tough, fibrous cushion, called an intervertebral disc, which contains a jelly-like substance. These discs act as cushions absorbing shock and allowing the spine to bend, twist and turn. Healthy discs are thick, flexible and compress when pressure is put upon them, like a sponge.

When there is an injury, the vertebra may shift out of alignment or compress the disc causing the disc to bulge or rupture, out the jelly like substance. This herniated disc or bulging disc causes pressure on the spinal nerves, resulting in pain, numbness, and may progress to decreased function in the affected arm or leg.
It is also known as:
• a pinched nerve
• sciatica
• a blown out disc
• a slipped disc

The protrusion of the disc or its core material not only causes pressure on the spinal nerves, it compresses blood vessels and interferes with circulation to the area. Deprived of nutrients and oxygen, the disc cannot heal, and, over time, flattens, becoming stiff and hard, just like a dry sponge. This condition develops into degenerative disc disease.

Standard treatment has included:
• Physical/chiropractic therapy
• epidural injections (an injection into the epidural space of the spinal cord)
• NSAIDs (Nonsteroidal Anti-inflammatory Drugs)
• Hot or cold packs with massage
• Electrical stimulation (TENS)
• Non-Surgical Spinal Decompression
• Acupuncture
• Surgery – as a final resort

A treatment method that is gaining support is Non-Surgical Spinal Decompression, in which some studies show a success rate of 71% to 90%. An FDA approved machine, using a computerized program gently stretches the patient’s spine, slowly drawing the vertebrae apart, relieving pressure on the disc, allowing it to heal.
Testing of the machine continues and a recent study compares treatment results of Decompression Therapy with that of the TENS ( Transcutaneous Electrical Nerve Stimulation) unit. TENS is a small unit which can be worn during therapy. This FDA approved treatment for back pain delivers low-volt electrical current to the affected area through electrodes. Its electrodes pierce the skin just deep enough to reach nerve fibers, usually 1 to 2 inches. It activates the body’s pain fighting mechanisms and may be used several hours a day.

The Study
The object of the study was to compare the effectiveness of the two treatment methods in relieving pain and improving mobility in patients with a bulging or herniated disc.

Subjects were recruited through newspaper advertisements and had to meet several criteria for inclusion in the testing:
• Disc protrusion or herniation confirmed by MRI (Magnetic Resonate Imaging) or CT scan (Computerized Tomography)
• Low Back Pain for 3 months or more; could be associated with pain radiating to one or both legs.
• Average duration of pain was 7.3 years

The study enrolled 44 patients; the average age was 42 years. The group was initially divided into 2 groups of 22 people each.
• Spinal Decompression treatments consisted of 30 minute sessions, 5 times a week for 4 weeks. This was followed by once a week treatment for 4 additional weeks.
• The TENS Group received treatment with a TENS unit for 30 minutes daily for 20 days. This was followed by a weekly treatment for 4 additional weeks.
• Both groups were able to take anti-inflammatory and non-narcotic pain relievers.

The Results
The outcome was measured by the 10 centimeter Visual Analog Pain Scale (VAS) and a disability scale. The disability scale rated the subject’s ability to perform their most affected activity on a 0 to 4 scale, with 4 being "could do an activity without limitation".
Success was defined as a 50% improvement in the VAS, showing the degree of pain relief. Any decrease in disability was given a positive rating. During the study, 4 subjects dropped out, leaving 19 in the Decompression Group and 21 in the TENS Group, a total of 40 participants.

Conclusions:
Spinal Decompression:
• 13 out of 19 people (68.4%) showed improvement.
• The 6 months follow-up showed 7 out of 19 people maintained their level of improvement

TENS Treatment:
• 0 out of 21 subjects showed any improvement.
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Additional scientific studies are being planned or are underway now to demonstrate conclusively the treatment effectiveness of Spinal Decompression Therapy.