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Chronic Low-Back Pain and Related Disability Improved With Medium-Firm Mattress Use

Ratings of pain and disability improved more significantly among individuals with chronic non-specific low-back pain after substituting old mattresses for those rated medium-firm compared with firm, according to the findings of a double-blind, controlled, multi-centre trial conducted in Spain.

Francisco M. Kovacs, PhD, Kovacs Foundation, Palma de Mallorca, and colleagues recruited 313 otherwise healthy adults with chronic, non-specific low-back pain but no referred pain to using either a firm or a medium-firm mattress for 90 days. The 84 men and 229 women ranged in age from 18 to 82 years and had low-back pain for a median of more than 9 years. At randomisation, baseline characteristics were similar between the 158 participants in the firm mattress and in the 155 participants in the medium-firm mattress groups. The researchers assessed the participants' pain while lying in bed, upon rising, and the degree of disability at baseline and after 90 days of mattress use.

Multiple logistic regression analyses showed the change of mattress resulted in an improvement in pain while lying in bed (odds ratio 2.36), as well as improvements in pain upon rising (odds ratio 1.93) and disability (odds ratio 2.10) in those using a medium-firm mattress compared with a firm mattress.

At baseline 25.3% of those in the firm and 20.6% of those in the medium-firm groups reported taking medication for low-back pain, however the 90-day assessment revealed that such medication use had decreased to 14.6% and 14.5% of the firm and medium-firm groups.

Throughout the study period patients using the medium-firm mattresses reported less daytime low-back pain (P = .059), less pain while lying in bed (P = .064), and less pain upon rising (P = .008) compared with patients using the firm mattresses.

"The substitution of old mattresses with firm and medium-firm new ones was associated with more frequent discontinuation of drug treatment and relevant improvements in pain and disability," the authors report, but "the use of a mattress of medium firmness improves the clinical course of low-back pain in a higher proportion of patients than the use of a firm mattress." They conclude, "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."

Lancet 2003;362:1599-604.

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