Lack of effectiveness of bed rest for sciatica

Background and Methods Bed rest is widely advocated for sciatica, but its e ffectiveness has not been established. To study the effectiveness of bed re st in patients with a lumbosacral radicular syndrome of sufficient severity to justify treatment with bed rest for two weeks, we randomly assigned 183 subjects to either bed rest or watchful waiting for this period. The prima ry outcome measures were the investigator's and patient's global assessment s of improvement after 2 and 12 weeks, and the secondary outcome measures w ere changes in functional status and in pain scores (after 2, 3, and 12 wee ks), absenteeism from work, and the need for surgical intervention. Neither the investigators who assessed the outcomes nor those involved in data ent ry and analysis were aware of the patients' treatment assignments. Results After two weeks, 64 of the 92 patients in the bed-rest group (70 pe rcent) reported improvement, as compared with 59 of the 91 patients in the control (watchful-waiting) group (65 percent) (adjusted odds ratio for impr ovement in the bed-rest group, 1.2; 95 percent confidence interval, 0.6 to 2.3). After 12 weeks, 87 percent of the patients in both groups reported im provement. The results of assessments of the intensity of pain, the bothers omeness of symptoms, and functional status revealed no significant differen ces between the two groups. The extent of absenteeism from work and rates o f surgical intervention were similar in the two groups. Conclusions Among patients with symptoms and signs of a lumbosacral radicul ar syndrome, bed rest is not a more effective therapy than watchful waiting . (N Engl J Med 1999;340:418-23.) (C) 1999, Massachusetts Medical Society.