Basis, indications and risk

Treatments Basis, indications and risk Patient information Postural hygiene Exercise Maintaining level of Activity Bed rest Pharmacological therapy Neuroreflexotherapy (NRTI) Spinal column surgery Surgery for Pain and Pain Clinics Vertebral manipulation Behavioral treatment Epidural injections Facet joint infections Trigger point and ligament infections Rhizotomy Corsets and lumbar belts Traction Physical therapy/physiotherapy Electromyografic Feedback TENS: Transcutaneous electrical Nerve Stimulation Shoe insoles and shoe lifts Acupunture Recommended treatments

Bed rest

Objective

To wait until the cause of the pain remits spontaneously.

Theoretical base:

There are scientific studies that demonstrate that the nucleus pulposus that emerges from the fibrous sheath in a herniated disk tends to decrease in volume with time. Other lesions, like muscle sprains, tend to heal spontaneously. The logic behind the recommendation of bed rest was to allow time for this healing process, while at the same time protecting the spinal column from overload.

Evidence of efficacy:

Scientific studies coincide in their conclusion that bed rest is not effective in the treatment of back pain. For example, one study demonstrated that the group of patients with bed rest for a period of 2 to 7 days had a worse evolution than the group that maintained the degree of activity that their pain allowed them.

Risk and contraindications:

Besides not being effective, bed rest can be counterproductive. The available scientific evidence all points to the fact that bed rest, specially if it lasts longer than 4 days, produces loss of strength and makes the rehabilitation of the patient more difficult.

Indications

The existing recommendations based on scientific evidence coincide in discouraging bed rest as a treatment for back pain.

In some patients, the intensity of pain might force them to remain in bed for a few days, normally not more than 4, especially when there is radiated pain. But this should be considered a consequence of the pain, to be avoided whenever possible. It is therefore not a treatment, since it has no beneficial effect on the duration of the episode.