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Medium-firm Mattresses Best For Low Back Pain (pp 1594, 1599)

November 12, 2003

The popular belief that firm mattresses are best for people with low back pain is challenged by the results of a randomised trial in this week's issue of THE LANCET. Mattresses of medium firmness were found to be more effective than firm mattresses in alleviating symptoms of back pain.

Evidence surrounding the optimum firmness of bed mattresses is lacking; previous research has shown how three-quarters of orthopaedic physicians recommended firm bed mattresses to counter patients' low back pain. Francisco Kovacs from the Kovacs Foundation, Palma de Mallorca, Spain, and colleagues assessed the effect of different firmness of mattresses on the clinical course of patients with chronic non-specific low-back pain.

313 people had their own bed mattresses replaced with either a firm (rated 2.3 on a European scale of mattress firmness) or a medium-firm mattress (rated 5.6). Individuals were unaware of the type of mattress used in the study. Participants reported the degree of low back pain experienced whilst lying in bed and rising in the morning, as well as their degree of disability, before and three months after the start of the study.

Overall, people who used medium-firm mattresses in the study were twice as likely to report improvements in low back pain while lying in bed, when getting out of bed, and in disability associated with back pain; this was linked to a relative decrease in the need for pain-killing drug treatment.

Francisco Kovacs comments: "Our findings stress that recommendations for daily living, such as what kind of mattress to use, may have a relevant effect on the clinical course of low-back pain. The effects should be assessed with sound methods similar to those used for other medical treatments."

In an accompanying Commentary (p 1594), Jenny McConnell from the University of Melbourne, Australia, concludes: "Kovacs and colleagues' findings come as a relief for clinicians, who are not only struggling with the day to day management of patients with chronic low-back pain but are also constantly bombarded by the lack of efficacy of therapeutic interventions, which gives them few validated treatment options."

Lancet