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FAQ with a back pain expert

Back specialist Dr. Hamilton Hall had a lot to say about non-surgical spinal decompression therapy (a.k.a "traction"). Here is an edited transcript of our interview with Dr. Hall, as conducted by Marketplace's Erica Johnson:

How traction works

DR. HAMILTON HALL: It doesn’t always relieve the pain. That’s the frustration. Sometimes pulling apart feels good and some people say I love my traction because it makes me feel good. Other people say it didn’t make any difference at all. We don’t understand yet quite why sometimes it works and sometimes it doesn’t.

One factor would be the fluid within the disc and it’s not free fluid – let me make that very clear. You don’t put a hole in it and have it leak out. It’s like jello. So what happens is that as you get older and you lose this fluid content, the discs begin to narrow and even pulling them apart now isn’t going to make them fill again because the chemistry has changed and the water cannot be drawn back in. That’s what aging does. So that if I took a 70 year old and put them in traction, the effect would be negligible. It wouldn’t happen. If I take a 17 year old and put them in with very mobile discs, yes there would be some change.

ERICA JOHNSON: BUT NOT PERMANENT.

DR. HALL: But not permanent and not necessarily pain relieving.

80 per cent of back pain gets better

DR. HALL: Most back pain, first you have to understand, is a self-limiting problem. It gets better on its own. We’re talking now well over 80 per cent of the time. It tends to come back. Most people who have had a back attack will have a second attack within a year. So that getting rid of your attack today is actually the easy part of it. The hard part of it is how do I protect you from doing it again? That’s coming down to lifestyle, exercise, all those things that people don’t want to hear.

ERICA: IT’S ACTUALLY HARD WORK?

DR. HALL: Well it isn’t even hard work, but it requires a certain discipline that people may not have. Now this may feel good, it may not. But because the percentages are so high of normal recovery, they can guarantee success. You know, 80 per cent success, because 80 per cent are going to get better anyway.

On space technology

ERICA: HOW DOES ZERO GRAVITY AFFECT THE BACK?

DR. HALL: Well, it’s actually not good for the spine. It just changes the spine. The astronauts all get taller when they go into space. And actually in the very first time they spend time in space, the suits wouldn’t accommodate and they had to change it. That’s something they learned the hard way. They had trouble getting back into their suits because the suits weren’t taller. The suits now are adjustable so they can grow. They lose that extra height within a week of being back on the ground. They’re back where they started. Some astronauts have reported back pain after their time in space. Some have said their back didn’t change. There is no predictable outcome to having no gravity on your disc.

On alternative medicine

DR. HALL: I live in the world of natural therapy. I spend a good deal of my time, as a surgeon, dealing with manual therapy, dealing with education, dealing with people’s ability to control their own pain. I’m very aware of what’s out there. I’m also very aware of the things that are claimed and have been claimed over the years that, that don’t work but sound attractive.

ERICA: SO ARE YOU A CRITIC OF ALTERNATIVE THERAPIES?

DR. HALL: No, not alternative therapy so long as it is adequately effective and suitably priced. I’m not a fan of anything that takes your money and gives you back nothing but a sense of, well it ought to work, it costs so much.

ERICA: YOU THINK THAT’S WHAT’S GOING ON HERE?

DR. HALL: I’m afraid a lot of that is. I mean does traction help? As I said, sometimes yes. So are they getting traction? Of course they are. Are some people going to feel better for having it? Certainly they will. I can provide the same thing on a traction table without the fancy computer. I can give you the same effect with traction for a lot less money or no money if you can buy a home traction thing and just do it yourself, then good for you. But I can’t guarantee it’s going to stop your pain because traction just is not a guarantee of success with or without the computer.

On testimonials

ERICA: THERE A LOT OF TESTIMONIALS, PEOPLE WHO SAY THE DRX9000 WORKS.

DR. HALL: Testimonials are by miles the least scientific proof of anything.

ERICA: BUT THEY’RE SAYING THEY HAVE BACK PAIN RELIEF.

DR. HALL: That’s right. And remember what I told you about the 80 per cent of people that get better on their own. If during the course of your normal recovery you get traction and you get better, who’s to know whether it was normal recovery or whether it was the traction.

Well in any, any scientific model, that’s just not necessarily true. It could be a number of other things. It could have been something you didn’t even realize.

The only way to prove it is to take a set number of people, divide them in half. Half get the treatment, half don’t. They’re equal in every other way. Everything else about them is the same except one group is treated, one group is not, and then you look at the outcome over time to see what happens.

And if there is a statistically difference – statistical difference between the two. If there’s a statistical difference between those that are treated and those that are not, then you look at the treatment and say, this seems to be effective. Even then you’re going to be very cautious. But just to say, I went and had something done and therefore it works has absolutely no validity.

ERICA: BUT IT SOUNDS SO CONVINCING, THESE STORIES.

DR. HALL: They’re convinced themselves. There’s no reason for them not to be convinced. They’re convinced, they believe. They’re not lying. They’re not making the story up. They truly believe. But it’s very difficult for someone who is not a) grounded in a scientific method of evidence and prospective trials who has had a good response, who may have not had a good reaction to 3 or 4 other treatments because they just weren’t ready to get better yet.

And to come down and say, okay this is what we know for sure, this is what we don’t know, is a very difficult call. And in spine, where things get better on their own, where so many different things can have a beneficial effect, where surgery has a very narrow role and yet it’s always picked on as, oh my god, don’t have surgery, you know, because surgery has such a limited place to play, it’s wide open to everybody else. And this sort of thing, and it’s not just this, there’s so many other types of treatment, ah that just don’t have scientific basis but people give testimonials.

On how MRIs are unreliable

ERICA: HOW GOOD ARE MRIs AT DIAGNOSING BACK PAIN?

DR. HALL: MRI is a very interesting subject all by itself. It is not an x-ray. I don’t think people realize this. The MRI is actually a computer generated picture of body water. That’s what it is. And it shows the amount of water in the disc so –

ERICA: AND YOU’RE LOOKING FOR A LOT OF WATER?

DR. HALL: Normal discs have lots of water. Old discs turn black. They lose their water. An MRI can show you how old you are. It shows you the amount of water. Now as a screening tool, as a way of assessing back pain, MRI carries with it and this is a very important statistic, a better than 60 per cent false positive.

ERICA: FALSE POSITIVE?

DR. HALL: False positive. More than 60per cent of the time the MRI will show something wrong, but it’s not causing any trouble. If I take a picture of your back, an MRI, there is a 60per cent chance I will find something, whether you have any back pain or not. So using the MRI as a way of screening backs means that most of the people I see will have something. And I can point to it and I can say, look, that disc has less water than that disc. Let’s get you into traction and let’s suck the water back in.

ERICA: PEOPLE THINK MRI, SCIENTIFIC EVIDENCE.

DR. HALL: It’s magic. It’s the new technology. And in fact it’s not. It’s, as a tool for looking at cancer, for example, it’s awesome. The things MRI can show us are really magic. They are great. But as a way of saying, do you have back pain or not, what’s your back pain caused by, as I’ve said, more than 60 per cent there will be something there that has nothing to do with the real source of the pain.

Back pain tips

ERICA: IN A NUTSHELL, WHAT SHOULD PEOPLE DO FOR GOOD BACK CARE?

DR. HALL: They should first of all understand that it’s not dangerous. Understand that the pain does not relate to the seriousness of the problem. Understand that it’s almost always self-limiting, that it gets better.

Understand that moving, particularly in directions that reduce the pain is the right thing to do and do early. Stay out of bed, stay active, stay with the things that work and develop some skills in how to sit, how to stand, how to lift, how to bend. Just simple body mechanics, that makes all the difference.

Tags: medicine