Does home-based tilt-table inversion traction therapy reduce pain in people with chronic discogenic low back pain (LBP)?

This study is investigating whether the use of inversion therapy may reduce pain in chronic LBP patients, where it is thought that the pain is associated with the intervertebral disc (i.e. discogenic pain), According to a heuristic assessment protocol of a prominent Musculoskeletal Pain Specialist with many years experience of using Inversion therapy for LBP. In this study inversion therapy will be performed using the Teeter tilt-table. We are looking to test whether four weeks of at-home inversion therapy is beneficial for people who have had LBP for more than six months, either with or without leg symptoms, which is suspected to involve the disc, and which has not settled with conventional therapy. If participants are randomised into the inversion group (and have tolerated the inversion at the initial appointment and prior to randomisation), a tilt-table inversion machine will be delivered to their home for the four weeks of the trial. They may also continue with their usual care, as directed by the specialist. They will be expected to complete the inversion to 45 degrees, for 3 sets of 2 minutes (with 1 minute rest - in the upright position - between the 3 sets), twice (2 times) a day. So this would require 20 minutes a day. Also to encourage fidelity amongst the inversion group we will be asking them to complete a daily inversion diary. It is well accepted, with respect to LBP, that the research, the current assessment and management knowledge is lmited, consequently it is difficult to be confident in the definition and diagnosis of LBP. We are basing our assessment of likely discogenic LBP on the work of Waddell (1987, 2005), Chou et al., (2007), and Chanda et al., (2011) concerning the diagnositic triage; as well as the work of Bogduk (2009) on referred pain; and researchers who have undertaken studies to help rule out hip (Brown et al., 2004), and SIJ disorders (Laslett et al., 2003; Szadek et al., 2009). So the heuristic assessment protocol (detailed within the Inclusion and Exclusion criteria with respect to discogenic LBP) that we are testing (as well as the effect of inversion on this particular presentation of LBP) is based upon these sources. It is not 'newly developed' per se, as it is used in clinical practice but, in itself, has not been previously studied or validated;