1. Aetna considers pneumatic cervical traction devices for home use medically necessary durable medical equipment (DME) to alleviate pain caused by paravertebral muscle spasm when all of the following criteria are met: 
   1. The member has completed a 6-week course of physical therapy in the outpatient setting and still has pain; and
   2. The member has failed medical therapy (e.g., oral anti-inflammatory medications, muscle relaxants); and
   3. The doctor prescribes 20 pounds or more of home cervical traction; and
   4. Any one of the following criteria is met:
      1. The member failed a trial of over-the-door cervical traction;* or
      2. The member has temporomandibular joint disease which may become worse with over-the-door cervical traction; or
      3. The member has distortion of the neck or chin (e.g., radical neck dissection) making use of a chinstrap impractical, and

   5. The member has had a series of trials of this device in the outpatient setting before being sent home with one; and
   6. Home therapy is being supervised by a physical therapist
      
      
2. Aetna considers pneumatic cervical traction devices experimental and investigational for all other indications.

* Over-the-door cervical traction is considered medically necessary DME for persons with chronic neck pain.

Note: A one-month rental is deemed medically necessary when the above medical necessity criteria are met.  Purchase may be considered medically necessary for persons whose symptoms have improved following a one-month trial.

The prevalence of non-traumatic mechanical neck disorders (neck pain) in the United States is 10%.  The anatomic source may be myofascial, ligamentous, osseous, neurologic, cutaneous, or visceral.  Possible causes include: 1) compression of neural structures resulting in spasm and radiculopathy; 2) inflammatory, neoplastic, infectious, or degenerative processes; or 3) disruption of tissue secondary to trauma.  Acute phase treatment of neck pain in the physical therapy outpatient setting includes moist heat, gentle massage and temporary immobilization with a cervical collar that holds the neck in slight flexion.  Ultrasonic treatments, especially combined with low frequency current electrotherapy of the muscles may be helpful.  Therapies with low frequency pulsating electromagnetic field and laser photobiostimulation have also been proved successful.  Patients with cervical herniated nucleus pulposus and radiculopathy are usually treated with an aggressive physical rehabilitation program.  For chronic neck pain, no treatment is necessary except for non-narcotic analgesics for symptoms, and avoiding any type of activity or work, which causes strain of the neck.

For decades, cervical traction has been applied widely for pain relief of neck muscle spasm or nerve root compression.  It is a technique in which a force is applied to a part of the body to reduce paravertebral muscle spasms by stretching soft tissues, and in certain circumstances separating facet joint surfaces or bony structures.  Additional pounds for cervical traction is usually utilized in the hospitals or clinics for temporary use and in certain situations and under observation with occasional imaging, making sure of not to destabilize the spine.  Studies have shown that traction must be constant so that the muscles may tire and the strain falls on the joints.  It generally takes 2 minutes of sustained traction before the intervertebral spaces begin to widen.  Forces between 20 and 50 pounds are commonly used to achieve intervertebral separation.

Cervical traction is administered by various techniques ranging from supine mechanical motorized cervical traction to seated cervical traction using an over-the-door pulley support with attached weights.  Duration of cervical traction can range from a few minutes to 30 min, once or twice weekly to several times per day.  Anecdotal evidence suggests efficacy and safety, but there is no documentation of efficacy of cervical traction beyond short-term pain reduction.  In general, over-the-door traction at home is limited to providing less than 20 pounds of traction.

Pneumatic cervical traction devices (e.g., Hometrac, Pronex) were developed to deliver cervical traction in the home comparable to forces applied by physical therapists in the outpatient setting.  The patient is instructed in home traction to relieve symptoms, an exercise routine to relieve spasm and discomfort, and to report any weaknesses, eye symptoms, and bladder or bowel incontinence immediately. 

There are some who argue that pneumatic cervical traction should be offered as first line therapy in preference to over-the-door cervical traction, asserting that pneumatic cervical traction is superior to over-the-door cervical traction.  There are, however, no studies in the peer reviewed published medical literature comparing over-the-door cervical traction with pneumatic traction devices.  Although pneumatic devices are able to provide more force than over-the-door traction devices, there are no peer-reviewed published clinical studies proving that clinical outcomes are improved by applying greater traction force.  In addition, the potential adverse effects of the application of large amounts of cervical traction with pneumatic devices in the home setting have not been sufficiently evaluated in well-designed published clinical studies.  There is also no published peer-reviewed evidence proving that pneumatic traction devices result in less irritation, improved compliance, or improved outcomes compared to over-the-door traction.  For these reasons, the use of pneumatic cervical traction devices are reserved for persons with neck pain who have failed over-the-door cervical traction.  

No matter how clinically effective a therapy is found to be, the treatment process, especially when it is dependent upon home use, is highly dependent upon patient compliance.  So, these patients must undergo adequate follow-up to assure proper usage.