Clinical Question: Is bed rest effective in the short-term treatment of patients with back pain and sciatica?

Setting: Various (meta-analysis)

Study Design: Systematic review

Synopsis: In this update of a 1999 Cochrane Review of trials on bed rest for short-term (12 weeks) relief of low back pain or sciatica, authors searched multiple databases for published and unpublished randomized or quasi-randomized studies in any language. Two reviewers independently assessed the methodologic quality of each study and extracted the data. They assessed the quality using four criteria: (1) concealment of allocation; (2) cointervention; (3) intention-to-treat analysis or losses to follow-up; and (4) outcome assessment.

Since the 1999 review, the authors found only two new trials. Six trials consistently demonstrated that for patients with uncomplicated low back pain, bed rest was slightly worse than staying active for pain relief and return to functional status. For patients with sciatica, the data were less clear, but bed rest had little or no effect on pain or return to function.

Bottom Line: When studied for three months, bed rest in patients with uncomplicated low back pain causes more pain and slows return to function. Similarly, patients with sciatica experience, at best, no benefit with bed rest. (Level of Evidence: 1a)