4 days ago
Can low back pain be an easy fix? Lancet study finds a long-term therapy that gets you moving
Injury, strain, overwork, stress and fatigue led to crippling low back pain for Susan (name changed). 'Life was on hold' for Ann (name changed), who admits that her mindset 'My back is damaged and needs fixing, but there are no answers' led to a loss of confidence. These are some of the views from patients who were part of the RESTORE trial where they describe their journey and how cognitive functional therapy (CFT) helped them gain control over their bodies, pain and face other fears.
The latest study, published in 'The Lancet Rheumatology,' is significant because it establishes long-term effects of this therapy on people living with back pain. A previous study published in The Lancet found that CFT was more effective than usual care in improving physical activity among individuals with low back pain for up to a year. The current trial is the first to show that these effects can hold up to three years.
It focusses on helping individuals understand their pain experience, modify unhelpful beliefs and behaviour, eliminate the fear that movement is damaging the back further and develop strategies to manage their pain and improve function. 'CFT is a type of psychotherapy and findings of the trial show that long-term benefits can be achieved by self-management skills, pain control strategies and confidence to engage in valued activities apart from adopting a healthier lifestyle,' Prof Mark Hancock from the Spinal Pain Research Centre, Department of Health Sciences, Macquarie University, Sydney, said.
Dr Anand Gangwal, associate professor, Sancheti College of Physiotherapy, Pune, says self-management skills are extremely important in case of gradual onset pain, especially low back pain and neck pain. 'This kind of pain develops with micro trauma of the tissue due to our lifestyle and lack of correct posture and exercises. Medically we can't restore the damaged tissues to their original condition, especially as we get older. But we can control and reduce the microtrauma by lifestyle modification. This will help in reducing the rate of degeneration,' he says.
A key component is awareness of what exactly triggers/worsens their pain. That knowledge alone will help patients refrain/modify the activities. 'Along with this a physiotherapist should help in strengthening the supporting structures, so that patients can perform their activities of daily living pain-free. Mental stress, busy schedules, poor nutrition and poor body composition can further worsen chronic pain. All these factors need to be addressed,' Dr Gangwal argues.
Dr Mayur Kardile, consulting spine surgeon, Jehangir Hospital, Pune, has seen patients with low back pain, who are afraid of any movement that causes pain or aggravates it. That kind of fear leads to inactivity and can worsen the pain worse over time. 'The patient gets into a negative feedback loop and this creates a cycle that's hard to break. With CFT, patients are progressively challenged to undergo better exercises, slowly and safely guided to move again and face the things they've been avoiding,' he adds.
This 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 (a technique using sensors to measure body functions such as heart rate and enable the patient to modify them). Those who received CFT and CFT plus biofeedback saw improvements in their physical activity participation over usual care.
Anuradha Mascarenhas is a journalist with The Indian Express and is based in Pune. A senior editor, Anuradha writes on health, research developments in the field of science and environment and takes keen interest in covering women's issues. With a career spanning over 25 years, Anuradha has also led teams and often coordinated the edition.
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