Effect of firmness of mattress on chronic non-specific low-back pain: Randomised, double-blind, controlled, multicentre trial

Hospital Universitario Ramón y Cajal, Madrid, Madrid, Spain
The Lancet (Impact Factor: 45.22). 12/2003; 362(9396):1599-604. DOI: 10.1016/S0140-6736(03)14792-7
Source: PubMed


A firm mattress is commonly believed to be beneficial for low-back pain, although evidence supporting this recommendation is lacking. We assessed the effect of different firmnesses of mattresses on the clinical course of patients with chronic non-specific low-back pain.
In a randomised, double-blind, controlled, multicentre trial, we assessed 313 adults who had chronic non-specific low-back pain, but no referred pain, who complained of backache while lying in bed and on rising. Mattress firmness is rated on a scale developed by the European Committee for Standardisation. The H(s) scale starts at 1.0 (firmest) and stops at 10.0 (softest). We randomly assigned participants firm mattresses (H(s)=2.3) or medium-firm mattresses (H(s)=5.6). We did clinical assessments at baseline and at 90 days. Primary endpoints were improvements in pain while lying in bed, pain on rising, and disability.
At 90 days, patients with medium-firm mattresses had better outcomes for pain in bed (odds ratio 2.36 [95% CI 1.13-4.93]), pain on rising (1.93 [0.97-3.86]), and disability (2.10 [1.24-3.56]) than did patients with firm mattresses. Throughout the study period, patients with medium-firm mattresses also had less daytime low-back pain (p=0.059), pain while lying in bed (p=0.064), and pain on rising (p=0.008) than did patients with firm mattresses.
A mattress of medium firmness improves pain and disability among patients with chronic non-specific low-back pain.

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Available from: Francisco M Kovacs
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    • "In addition to its effect on sleep, bed comfort is often linked to low back pain, a leading cause of temporary disability and sick leave (Ehrlich, 2003). Although the causes of non-specific back complaints are not well understood, it has been shown that low quality bed systems may contribute significantly to the onset or persistence of low back pain (Kovacs et al., 2003). Consequently, it comes to no surprise that ergonomic aspects of bed design have evolved substantially during the last decade. "
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    • "However, Sullivan added, ''Health-wise, a firmer bed surface is recommended for people with a bad back to keep the spine from sagging or from tiring the back muscles.'' Recently, a between-subject, double-blind study showed that the use of medium-firm mattresses rather than firm mattresses for 90 days provided greater relief to people who had chronic non-specific low-back pain (Kovacs et al., 2003). This study points out that at least for people with low-back pain, it is not appropriate to select beds based on the firmer the better principle. "
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