For years, “rest” – generally meaning a few days to a week in bed – was the standard prescription for acute low-back pain. More recently, doctors have started counseling back pain patients to stay as active as they can.
The latter approach has now been confirmed by a new Cochrane Library review. According to Kristin Thuve Dahm, a researcher at the Norwegian Centre for the Health Services and lead author of the review, “Normal daily activity seems to be the best way for patients with low-back pain to get better.”
The review directly compared bed rest and staying active, in patients with and without sciatica (low-back pain accompanied by signs of nerve compression or damage, causing numbness, tingling or weakness in the leg).
The comparison between bed rest and normal activity for low-back pain without sciatica used data from three studies that included 481 patients. All three found improvements in pain intensity with both treatments, with no significant differences between them. One of the studies, however, involved a highly specific group of patients – young combat trainees who were hospitalized for their back pain – “and thus, it’s applicability to the general population is questionable” the authors wrote.
In comparing treatments for sciatica, the reviewers analyzed data from two studies of 348 patients. No difference existed in pain intensity, directly after treatment or 12 weeks later, between sciatica patients who received advice to stay active and those whose doctors prescribed bed rest. Similarly, there was no difference between groups in patients’ ability to function.
“The available evidence neither supports nor refutes that advice to stay active is better than resting in bed for people with sciatica,” Dahm said. “However, considering that bed rest is associated with potential harmful side effects, we think it is reasonable to advise people with sciatica to stay active.”
Given that back pain is the second leading cause of absenteeism from work, after the common cold, this new advice could have a massive economic impact on society. Estimates suggest that back injuries account for 15% of sick leave, or over 100 million lost days of work annually in the US.
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