The RCGP - Clinical and Special Projects, Clinical Guidelines, Acute Low Back Pain. Contents, Index page


Chapter 2

Evidence Review

Drug Therapy

Paracetamol, paracetamol-weak opioid compounds, NSAIDs

Muscle relaxants

Strong opioids

Antidepressant Medications

Bed Rest

Advice on Staying Active

Bed Rest

There are now 9 RCTs of bed rest for acute or recurrent LBP with or without referred leg pain. These consistently show that bed rest is not effective. The only trial showing positive results for bed rest was very atypical and the results cannot be applied to U.K. primary care. (Wiesel et al 1980). Despite widespread practice, there is little evidence on the efficacy of bed rest for disc prolapse or nerve root pain. The only RCT is a very early trial of poor methodological quality, but showed that bed rest is not as effective as epidural anaesthesia (Coomes 1961). There is no evidence that hospital bed rest is any more effective.

For acute or recurrent LBP with or without referred leg pain, bed rest for 2-7 days is worse than placebo or ordinary activity. It is not as effective as the alternative treatments to which it has been compared for relief of pain, rate of recovery, return to daily activities and days lost from work.
Prolonged bed rest may lead to debilitation, chronic disability and increasing difficulty in rehabilitation.

Koes & van den Hoogen 1994, Waddell et al 1996 (Table 3)


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