Psychotherapy Offers Chronic Back Pain Relief for Three Years

Newsweek

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A type of psychotherapy called cognitive functional therapy (CFT) could help give people with chronic low back pain lasting relief for at least three years.
This is the conclusion of a study led by researchers at Curtin University and Macquarie University in Australia, which demonstrated that CFT is the first treatment with good evidence to show that it can effectively reduce patient's pain-induced disability for more than a year.
Around 8.2 percent of American adults have chronic severe back pain and nearly three-quarters of these patients have difficulties with mobility, social participation, self-care or work participation, according to the National Center for Complementary and Integrative Health.
A previous study found that CFT was more effective than usual care—including painkillers, physical therapy and/or massage therapy—at improving self-reported physical activity in those living with low back pain for up to one year. The current randomized controlled trial is the first to show these effects are sustained for up to three.
Man from behind with hands on lower back pain.
Man from behind with hands on lower back pain.
kieferpix/Getty Images
"Cognitive behavioral therapy (CBT) is more of a talking therapy while CFT is more of a doing therapy—building trust, confidence and awareness in the body," study author and Macquarie physiotherapy professor Mark Hancock told Newsweek.
"This is done through movement control and body relaxation during graduated exposure to feared and avoided movements and activities. CFT also addresses relevant lifestyle factors."
RESTORE included 492 patients with chronic low back pain in Australia, who were randomly assigned to receive eight treatment sessions of usual care, CFT, or CFT plus biofeedback (which uses sensors to measure body functions like heart rate and enable the patient to modify them.)
"CFT was delivered in the first three months [for those who had it] with one top up session at six months. There was no CFT intervention after this. This is the exciting finding—that the effect lasted. The intervention focuses on empowering patients to understand and manage their condition, so while we were pleased we were also not surprised," Hancock explained.
While those who received CFT and CFT plus biofeedback saw improvements in their physical activity participation over usual care, the difference between these two groups at three years was small and insignificant, also consistent with the three-month and one-year results.
Therapist with smiling patient on sofa.
Therapist with smiling patient on sofa.Overall, CFT significantly reduced people's back pain and improved their function, which was largely maintained over three years of follow-up.
"CFT uses a multi-dimensional clinical reasoning framework to identify and target the key factors contributing to each person's chronic back pain. It has three key elements," said Hancock.
The first is "making sense of pain"—helping to guide a reconceptualization of pain from what the researchers call a 'biopsychosocial' perspective through the lens of the patient's own experience.
Second is "exposure with control"—guiding pain and movement control strategies to build confidence for people to re-engage in valued activities like physical activity, work and social life.
The third elemtent is "lifestyle changes"—promoting positive physical, social and psychological health.
"It targets the root causes and that is why we believe it has long term effects unlike most treatments for back pain that just address the symptoms," Hancock added.
"Mind and body approaches are key because beliefs impact our behaviors and pain experience [also building anxiety and fear]. If people believe their back is fragile, unstable and damaged, they brace and avoid activity. This sets off a negative spiral. Effective care must address both the physical and psychological factors that can't be separated."
Woman lifting small dumbbells with medical professional.
Woman lifting small dumbbells with medical professional.
Harbucks/Getty Images
In all groups in the study patients could receive other interventions if they wanted, so the difference between groups was the CFT, Hancock explained.
RESTORE demonstrates that CFT has long-term benefits on physical activity of those with low back pain and provides an opportunity to markedly reduce its impact if the intervention can be widely implemented, the authors said. Its implementation requires scaling up of clinician training to increase accessibility and replication studies in diverse healthcare systems.
"CFT can help almost all people with chronic low back pain, apart from those with serious causes like cancer, infection or fracture. That said it is not a magic cure, and there is more work to do. We found about 70 percent of people responded well but we still need to explore how we help the others. Interestingly, the effects were greatest for the worst affected patients," said Hancock.
"Almost certainly, these principles extend beyond back pain and research is underway for other conditions."
Hancock believes health policies should support interventions like CFT due to them being high-value, low-risk and sustained.
"Some of the authors have developed this social enterprise to educate the public about back pain and to provide training resources for clinicians. We are currently training clinicians in several countries," added Hancock.
He concluded: "Funding is a barrier to people getting this [the CFT] and other good care for back pain. In many countries, expensive and potentially harmful interventions like surgery, injections, imaging and opioids are covered but effective safe interventions like CFT are not. This needs to change."
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Reference
Hancock, M., Smith, A., O'Sullivan, P., Schütze, R., Caneiro, J. P., Laird, R., O'Sullivan, K., Hartvigsen, J., Campbell, A., Wareham, D., Chang, R., & Kent, P. (2025). Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): 3-year follow-up of a randomised, controlled trial. The Lancet Rheumatology. https://doi.org/10.1016/S2665-9913(25)00135-3