Bed Rest for Back Pain: Is it a Good thing?

Bed Rest Not Much Good for Anything?

Bed rest hasn�t proven to be an effective treatment for much of anything.

Bed rest hasn�t proven to be an effective treatment for back pain or sciatica. According to a new systematic review, bed rest hasn�t proven to be an effective treatment for much of anything. Chris Allen and colleagues from the University of Queensland in Australia systemically searched MEDLINE and the Cochrane Collaboration library for randomized controlled trials published from 1966 to June 1998 comparing bed rest to early mobilization for any medical condition. They included trials in the review only if the main difference between treatment groups was the amount of bed rest. (See Allen et al., 1999.) They found randomized trials comparing bed rest to early activity for the following conditions: lumbar puncture, spinal anesthesia, radiculography, cardiac catheterization, acute low back pain, spontaneous labor, proteinuric hypertension during pregnancy, early threatened abortion, uncomplicated myocardial infarction, pulmonary tuberculosis, rheumatoid arthritis, acute infectious hepatitis, and a variety of postsurgical conditions. Of trials examining bed rest as a primary treatment, none found a statistically significant advantage to bed rest. Six studies found outcomes to be better with bed rest, but not significantly so. Editor�s note: A study by Wiesel et al., a randomized trial which found an advantage to bed rest among soldiers with back pain, did not meet he inclusion criteria of this review.] �In 24 trials of bed rest after various medical procedures, seven outcomes were better with bed rest, but none significantly so,� according to Allen et al. The researchers� conclusion: �We should not assume any efficacy for bed rest. Further studies need to be done to establish evidence for the benefit or harm of bed rest as a treatment,� Allen et al. assert. Just because bed rest is not an effective therapy doesn�t mean it can be eliminated from patient care altogether. Even when it is not an effective therapy it may be an unavoidable consequence of illness. Some patients may need a couple of days in bed before they return to normal. Yet Allen et al. suggest that clinicians bear in mind the conclusion of 1944 article by W. Dock, entitled �The Evil Sequelae of Complete Bed Rest.� �The physician must always consider complete bed rest as a highly unphysiologic and definitely hazardous form of therapy, to be ordered for specific indications and discontinued as early as possible.� (See Dock, 1944.) This advice rings particular true in the treatment of back pain. Heeding this warning in 1944 might have staved off 50 years of inappropriate, debilitating treatment, and unnecessary disability.

References:

Allen C et al., Bed rest: A potentially harmful treatment needing more careful evaluation, The Lancet, 1999; 354:1229�33. Dock W, The evil sequelae of complete bed rest, JAMA; 1944, 125:1087�90.m

Article taken from "The Back Letter" Volume 13, Number 12, 1999

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