SECOND OPINION

EXPERTS on the treatment of backache are now agreed that, in most circumstances, rest does more harm than good. This is a radical change in attitudes: 10 years ago all the standard textbooks recommended that someone whose back had suddenly become painful should go to bed and stay there until the pain had disappeared. Now the advice is likely to be to keep active, often with back exercises.

Changing doctors' minds on an issue of this kind takes a long time. If a new treatment is based on a new drug or requires some new equipment, the manufacturers can be relied on to set up meetings to explain why change is needed. If, however, no one has a financial incentive to make changes, the process will take longer. Research studies will appear in medical journals, but by no means all doctors keep up to date with their reading.

More important, doctors - and especially older ones - may be reluctant to accept that the advice they have given their patients for years has been wrong. Another complicating factor is that the patients themselves may be reluctant to change their minds about what treatment is appropriate for them.

In the case of backache, these processes of change are still under way. One research study (published in the New England Journal of Medicine) looked at employees of the city of Helsinki who went to their health clinic with recent low-back pain. They were assigned at random to one of three treatments: two days' complete bed rest; a course of exercises involving bending and stretching to be done every two hours until the pain subsided; or the advice simply to get on with ordinary daily tasks as actively as possible. Recovery was quickest in the group told to get on with their lives. They took four days off work, the exercise group took six, and the people told to rest in bed took eight.

A second study, reported in the British Medical Journal, looked at a group of 81 young adults attending the Nuffield Orthopaedic Centre in Oxford who had had back problems on and off for as long as eight years. They were taught some back exercises, and half were enrolled in a programme in which they came to the hospital twice a week to carry them out. The patients who attended the supervised fitness programme showed much more improvement than the others who had to do their exercises at home. Part of the explanation may have been the support given by attending a group; but another may have been the unwillingness of sufferers to take more exercise at home. People need to believe in a treatment to carry it out.

Belief may, indeed, be an important factor in the successes achieved by osteopaths, chiropractors and others who will manipulate the joints of people with persistent backache.

What conclusions can be drawn? First, bed rest now seems to be out of the frame (except for people with severe backache that causes pain to radiate down the leg, suggesting a disc problem). People who have repeated attacks of back pain over a period of years may need psychological support to back up an exercise programme. It seems, though, that most people with backache of recent onset will get better whatever is done - and they might as well be told to take some pain-relieving tablets and get on with their lives as best they can.