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Study Says Backache Victims Should Work, Not Rest

October 22, 1986

BOSTON (AP) _ Most people with backaches should get back to work as soon as possible, even if it still hurts, and doctors’ traditional prescription of a week in bed is unnecessary and maybe even harmful, new research suggests.

Dr. Richard A. Deyo of the Seattle Veterans Administration Medical Center said prolonged confinement can cause patients to lose muscle strength and it also may be bad for the circulatory system.

In addition, he said, ″there is a psychological benefit to getting people back to their usual activity and reassuring them that they are going to be fine.″

In the study he directed, published in Thursday’s New England Journal of Medicine, researchers randomly assigned 203 backache sufferers with no evidence of nerve damage to spend either two days in bed or seven days.

In both groups, the pain went away after an average of 11 days. But those told to stay in bed two days missed 45 percent less work, though not everybody stayed in bed as long as they were told.

″We physicians have been guilty of being somewhat overprotective of patients and perhaps in the process unduly alarming them about how sick they really are,″ said Deyo. Instead of ″lengthy periods of time away from usual activity, the best prescription may really be to return as quickly as you can to doing your normal activities.″

However, the researchers cautioned that the get-out-of-bed approach applies only to people with simple backaches resulting from strain to muscles and ligaments, not those who have ruptured disks and other nerve damage, which may require longer bed rest.

″We wouldn’t ask people to go to work if they were in pain that really is disabling,″ said Dr. Andrew K. Diehl, another researcher in the study. ″On the other hand, it appears that people with mild pain can safely go to work without fear that they would further injure themselves.″

Aching backs are one of the nation’s most costly ailments. Deyo said that according to one estimate, Americans lose 10 million work days annually because of backaches, and $5 billion is lost in earnings and reduced productivity. After the common cold, backaches are the leading cause of missed work.

The new study, conducted at the University of Texas Health Science Center at San Antonio, supports the growing belief that most backaches will go away in a week or two, no matter what people do, and that less bed rest may be as good as more rest, if not better.

″It’s an excellent study,″ said Dr. Augustus White of Boston’s Beth Israel Hospital. ″It neatly documents a trend that we have incorporated into our practice of managing patients who have back pain.″

Another paper, published last year in the British Medical Journal, suggested that even a couple of days in bed may be too long. Dr. J.R. Gilbert and colleagues from McMaster University in Hamilton, Ontario, randomly prescribed three days of bed rest or none at all for two groups. There was no difference in the outcome of their cases.

Deyo said these two studies suggest that one or two days of bed rest is plenty, and ″no days of bed rest is certainly a viable option for a lot of people.″

In an editorial, Dr. Nortin M. Hadler of the University of North Carolina said the latest research means that people should decide for themselves how to deal with their backaches.

But Deyo disagreed. He said people should be encouraged to get going again even if they still have a little pain.

″My fear is that if it’s left entirely to the patient,″ Deyo said, ″he may assume that he shouldn’t be doing anything until the pain is completely gone, and that might be weeks.″

Getting back to normal activities, White added, ″tends to diminish what we call the three D’s: the depression, dependence and disability that can frequently go with back pain.″

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