Could cognitive function therapy be the answer to relieve lower back pain?

A leading cause of disability that affects nearly 10% of the world’s population, most common treatments for lower back pain (painkillers, physical therapy, and lifestyle adjustments) often give short-term, mild relief. However, new research suggests that there could be a new form of pain relief that could have longer-lasting effects.

Participants who had just eight sessions of a bespoke form of psychotherapy found that it was nearly three times more effective at relieving chronic lower back pain than other standard treatments, even years later. The study into cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain, originally published in 2023, had 492 participants. Each participant rated their pain as at least a four on a scale of one to 10, and reported that their pain had moderately to severely limited their physical activity for at least three months. Splitting participants into three groups, the randomised, controlled clinical trial found that CFT could produce large, sustained improvements for those with chronic, disabling low back pain, at a much lower cost than other kinds of care typically used. 

Now, three years after the initial research began, researchers have discovered that those sessions have continued to bring pain relief. When compared to the care people were already on (painkillers, therapeutic massage, or physical therapy), they found that individuals who had CFT sessions had almost triple the pain improvement. 

312 of the original participants from across the three groups (a group that received typical care, a group that received CFT, and one that received CFT with biofeedback as well) gave feedback at a three-year follow-up. Researchers revealed that those who received CFT had nearly three times the improvement in both pain and disability compared with the group that received typical care. Additionally, three times as many people in the CFT groups had disability scores so low on the questionnaire that their pain was no longer considered functionally disabling.

What is cognitive functional therapy?

Cognitive functional therapy (CFT) is an approach developed specifically to help address and manage disabling lower back pain. Used for different types of lower back pain, CFT helps individuals to understand their pain and decide on strategies to help them manage their pain, considering their goals and lifestyle. 

A CFT therapist helps the individual with chronic pain to understand the multiple sources and factors that can be affecting their pain, such as negative beliefs about their pain, pain hypervigilance, self-doubt, and negative psychological, emotional, and cognitive factors. Focusing on three main components, CFT helps individuals to make sense of their pain, to experience exposure with control (understanding that changing movement patterns can help them to correct their pain), and lifestyle changes. 

Taking a holistic approach that combines patient movement with open, empathic, non-judgmental communication, individuals with lower back pain can move away from negative beliefs with the help and support of positive health behaviours being promoted. Cultural factors, willingness to change, and individual preferences and expectations are all taken into account. 

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What’s the difference between CFT and CBT?

With some similarities, CBT and CFT are two distinctly unique approaches. CBT (cognitive behavioural therapy) aims to help improve psychological factors through identifying and changing unhelpful thought patterns, behaviours, and environments. CFT focuses on enabling the therapist to lead their patient to effectively self-manage their condition through making sense of pain, exposure with control, and lifestyle changes. CBT focuses on improving pain management and ways of coping mentally, while CFT combines physical and mental elements.