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LOW BACK PAIN - SURPRISING RESULTS ABOUT MATTRESS FIRMNESS
(October 2004)

Low back pain is a very common problem; 80 percent of adults will suffer from significant low back pain sometime during their adult lives. For many, the pain is chronic. Diagnosable abnormalities such as disease of the discs between the vertebrae of the spinal column may be present, but, more often, no specific cause can be determined. The standard recommendation is a firm mattress, and the view of health care providers is often “the firmer, the better”. A group of investigators from Spain have now done a randomized, controlled trial of mattress firmness on 313 adults with non-specific low back pain who complained of back pain when in bed and on arising. During the study period of 90 days, participants slept either on a firm mattress or a medium-firm mattress. A soft mattress was not studied. The measurements were: pain in bed; pain on rising; and pain during the rest of the day. The mattresses were installed into participants homes without informing them whether the mattress was quite firm or medium firm.

The results were intriguing. On every measure made including extent of pain in bed pain, on rising and during the day, and extent of improvement during the 90-day period, those using the medium firm mattress did better than those using the firm mattress.

The conclusion was “a mattress of medium firmness improves pain and disability among patients with chronic non-specific low back pain”.

Commentary: This is a good study. It is well conducted, but it is not the last word. Most of the findings favoring the medium firm mattress over the very firm mattress were of borderline statistical significance. Additionally, the back pain may have been more severe for some of those on the firmer mattress. Furthermore, a greater percentage of those on the medium firm mattress slept on their sides in a fetal position. That position could have been important in their pain relief. Although it would have been nice to have a third group with a soft mattress, it would have been easy for the participants to recognize it was soft, and that recognition that the mattress was soft could bias the results; so it would have been nice to have the third group, but it also would have been difficult to interpret the results.



A good study, but, again, it is important to emphasize that it is one of only a very few studies that are designed well enough to have confidence in the results. More good studies are needed. Additionally, there are bound to be individual variations in what does or does not work both in regard to sleeping position and mattress firmness; some people may require the firm mattress even if, for most, the medium firm mattress produced better results. It should encourage health professionals to be less dogmatic about mattress firmness recommendations, but that does not suggest soft mattresses are okay for those with chronic low back pain.

Kovacs, F.M., et al. Effect of firmness of mattress on chronic, non-specific low back pain. Lancet. Vol 362 (November 15) Pgs 1599-1604. 2003.

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