2 days ago
Back Pain Relief From This Therapy Can Last for Years
back pain treatments that offer lasting relief, or any relief.
That's why a surprising new study, published Wednesday, is drawing public and clinical attention, showing that adults with disabling low-back pain who completed just eight sessions of a novel therapy saw sustained improvements in their pain and activity levels – even after three years.
The treatment, called cognitive functional therapy (CFT), blends physical therapy with a psychology-based approach.
CFT "teaches patients how to manage their own symptoms, what their pain experience means, and how they can move forward without injuring themselves," said Chad E. Cook, PT, PhD, a pain researcher at Duke University in Durham, North Carolina. (Cook was not involved in the study.)
Teaching people to self-manage pain is the cornerstone of the approach, Cook said. It's "why the authors saw improvements at three years – which is very uncommon."
The study included 312 adults in Australia with an average pain level of 4 or more on a 10-point scale – enough to interfere with daily living and work activities.
Of those who completed the CFT (which included seven 30- to 60-minute sessions over 12 weeks, plus an eighth "booster" session at 26 weeks), more than 40% saw improvement in their activity level – and maintained that improvement after three years, compared to 17% in a comparison group who received usual care.
Pain scores dropped by an average of 2 points in the CFT group, compared with less than 1 point in the usual care group, and that was also sustained after three years.
The average age of people in the study was 48, but benefits were seen among a wide range of ages, said study author Mark Hancock, PhD.
Here are three things to know about CFT for low-back pain, a condition that affects more than 1 in 4 U.S. adults.
CFT helped the people that nothing else worked for. Most people in the study did not expect the treatment to work, likely because other treatments they'd tried had failed.
"The poor outcomes of mainstream approaches are one of the reasons the authors created CFT," Cook said. "Before giving up, it is worth speaking with a CFT clinician to determine if the approach is right for you."
People with the most severe low-back pain have the most to gain: They're the ones who tend to reap the greatest benefit from CFT, the research showed.
CFT is low risk and can be done anywhere. There's no clear go-to therapy for low-back pain, and many options – like surgery or opioids – carry high risks. Research on most treatments shows mixed results, and scientists haven't yet figured out how to tailor them to individual patients.
But anyone can do CFT, anywhere. Many of the people in the study did their sessions via virtual appointments, although Hancock recommends doing the first session in person.
It's movement and psychotherapy combined.
A course of CFT is highly personalized, but it might include:
Tailoring therapy based on what's causing your pain – an old back injury or past surgery, for example – and your experiences from treatments that didn't work
Tracking exactly when and where pain shows up – like if it worsens while sitting, climbing stairs, or after certain movements
Challenging unhelpful beliefs about pain, such as "I will never be able to work again" or "my posture is wrong"
Practicing specific movements and psychological strategies with the therapist – like learning to move despite discomfort, training your body not to respond by tensing up (known as muscle guarding), and focusing instead on relaxing the muscles (which can ease pain)
Relearning everyday movements that matter to you – such as standing or sitting without pain, walking the dog, or getting back on the bike – along with strength training and lifestyle habits that support recovery
Developing helpful internal monologues, like "I became mindful to my response to pain" or "I don't fear my pain anymore"
How Do You Get Started with CFT?
Because it's an emerging therapy, you may not readily find a CFT-trained physical therapist. If you can't find one close to you, Hancock suggested searching for a physical therapist who describes themselves as "more of a coach, helping you to understand your back pain and giving you skills and confidence to return to activity."
In the meantime, Hancock, a professor of physiotherapy and back pain researcher at Australia's Macquarie University in Sydney, offers these tips:
Try to keep moving during pain, rather than resting or avoiding activity. Relax and try to move normally.
View your pain as a warning sign, but not as message that damage is happening. If you gradually do more, the pain usually is reduced.
