North American Spine Society

View all recommendations from this society

Released October 9, 2013; updated April 8, 2019

Don’t recommend bed rest for low back pain; patients should remain as active as possible and be encouraged to find positions of comfort and engage in activities that don’t worsen symptoms during an acute episode.

In patients with low back pain, bed rest has not been shown to be beneficial and has been shown to delay recovery.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

THIS CHOOSING WISELY DOCUMENT DOES NOT REPRESENT A “STANDARD OF CARE,” nor is it intended as a fixed treatment protocol. It is anticipated that there will be patients who will require less or more treatment than the average. It is also acknowledged that in atypical cases, treatment falling outside this recommendation list will sometimes be necessary. This document should not be seen as prescribing the type, frequency or duration of intervention. Treatment should be based on the individual patient’s need and physician’s professional judgment. This document is designed to function as a guide and should not be used as the sole reason for denial of treatment and services. This document is not intended to expand or restrict a health care provider’s scope of practice or to supersede applicable ethical standards or provisions of law, but to encourage discussion of these issues between physician and patient, encourage active patient participation in health care decision-making, and foster greater mutual understanding.

How The List Was Created

The North American Spine Society (NASS) appointed a multidisciplinary task force in 2012 to identify five areas in which to make recommendations. Based on the scientific evidence, existing clinical practice recommendations and expert opinion, the task force collaboratively identified a draft list of nine recommendations that was subsequently submitted to the NASS Board of Directors for review and ranking. After further refinement, the final list was reviewed and approved by the NASS Board of Directors and released in October 2013. In 2018, a multidisciplinary task force was established to review and revise the existing recommendations. The final revision list was reviewed and approved by the NASS Executive Committee.

NASS’ disclosure and conflict of interest policy can be found at: https://www.spine.org/Documents/WhoWeAre/DisclosurePolicy.pdf

Sources

Dahm KT, Brurberg KG, Jamtvedt G, Hagen KB. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev. 2010 Jun 16;(6):CD007612.

McIntosh G, Hall H. Low back pain (acute). BMJ Clin Evid. 2011;2011:1102.

Abdel Shaheed C, Maher CG, Williams KA, McLchlan AJ. Interventions available over the counter and advice for acute low back pain: systematic review and meta-analysis. J Pain. 2014;15(1):2-15.

Casser HR, Seddigh S, Rauschmann M. Acute lumbar back pain. Dtsch Arztebl Int. 2016;113(13):223-234.