Cognitive Functional Therapy: Fresh Hope for Those Suffering From Chronic Back Pain (2023)

Cognitive Functional Therapy: Fresh Hope for Those Suffering From Chronic Back Pain (1)

A new treatment for chronic back pain, called Cognitive Functional Therapy (CFT), has shown significant improvements in pain intensity and pain-related disability. The whole-person approach was tested on nearly 500 participants, who experienced large, clinically important reductions in pain and disability one year after the treatment.

In a study published in The Lancet, Cognitive Functional Therapy (CFT) showed significant improvements in chronic back pain sufferers, reducing pain intensity and disability while saving over $5,000 per person in healthcare and work productivity costs.

Long-term sufferers of chronic back pain experienced dramatic reductions in pain and related disability that remained at their one-year follow-up after taking part in a new treatment tested by Curtin-Macquarie-Monash University research. Published today in the leading medical journal The Lancet, the research found large clinically significant improvements in the intensity of pain and pain-related disability among almost 500 people who had been seeking help for their pain for an average of four years before trialing the new treatment.

The treatment, which delivered a healthcare and work productivity saving of more than $5000 per person, took a whole-person approach by also helping people to make lifestyle changes aimed at improving their social and emotional health.

(Video) Cognitive Functional Therapy for Low Back Pain

Lead author Associate Professor Peter Kent, from the Curtin School of Allied Health, said the findings produced compelling evidence that the new treatment had a large and lasting impact at a “clinically important” level.

Cognitive Functional Therapy: Fresh Hope for Those Suffering From Chronic Back Pain (2)

Retired mathematician Volker Rehbocks, a father of two, had been living with chronic back pain for at least 18 months. His GP told him that his gardening days were over, to avoid bending and lifting, gave him anti-inflammatories and advised him to rest his back. The constant pain and impact on his daily life left him feeling anxious and depressed. Mr. Rehbocks turned to the new treatment for help – and the difference has been life-changing. It only took about six to eight months to get his life back – he was quickly sitting comfortably, tying his shoelaces, bending, gardening, cleaning, working around the house and on his car, even lifting a cylinder head out of a car engine bay. Today, his mode of transport is rarely his car, opting to ride his bike large distances at a time with no pain. “My pain has effectively gone,” he said. Credit: Curtin University

“Lower back pain is the leading cause of disability across the globe, contributing to a loss of work productivity and early retirement worldwide,” Associate Professor Kent said.

“These exciting results give hope to the millions of people around the world who are disabled by back pain. It also provides a clear roadmap for clinicians, health services, and policymakers on how to reduce the growing burden of chronic back pain with a high-value, low-risk approach based on the best scientific evidence.”

(Video) Cognitive Functional Therapy Masterclass Part One - Peter O'Sullivan

The treatment, called Cognitive Functional Therapy (CFT), offered personalized and intensive coaching sessions that helped people make sense of their pain, focused on retraining them to move in ways that reduced their pain, and built confidence in movements and activities they had been afraid of or were avoiding. The treatment was delivered in 20 clinics across Perth and Sydney by 18 physiotherapists that were specifically trained to deliver CFT.

Participants living with chronic back pain – including many who had high levels of disability – tested the program in up to seven sessions over a 12-week period, followed by a booster session at six months. They were followed up by questionnaires until 12 months. More than 80 percent of the participants were satisfied with the treatment.

Cognitive Functional Therapy: Fresh Hope for Those Suffering From Chronic Back Pain (3)

Trial participant Volker Rehbocks and Curtin Professor Peter O’Sullivan. Credit: Curtin University

Co-author Professor Peter O’Sullivan, also from the Curtin School of Allied Health, who developed the new treatment, said it put the patient at the center of care.

(Video) Cognitive Functional Therapy Masterclass Part One - Kjartan Vibe Fersum

“This new treatment takes on board the individual characteristics of the person who has been living with chronic back pain by addressing their concerns and movement limitations under the skilled guidance of a trained physiotherapist,” Professor O’Sullivan said.

“This differs from traditional, more passive approaches – including massage, spinal manipulation, medication, and injections – because it puts the person in charge of their condition, helping them to understand the factors contributing to their pain, building control and confidence in their body to get back to valued activities. It was particularly rare and thrilling to discover that the significant reduction in pain and distress that these people living with chronic back pain experienced had remained right up to one year after trialing this new treatment.”

Co-author Professor Terry Haines, from Monash University, who investigated the economic efficiency, said the findings delivered significant healthcare and work productivity savings.

“The main economic efficiency results showed participants who took part in the CFT treatment saved more than $5,000 per person, largely driven by improvements in their productivity in both paid and unpaid work,” Professor Haines said.

“This has the potential to deliver significant savings to the global economy because we know the burden that lower back pain is contributing to a loss of work productivity and early retirement worldwide.”

Co-author Professor Mark Hancock, from Macquarie University, said the physiotherapists who carried out the new treatment across Perth and Sydney had experience in treating people with persistent lower back pain and underwent specialized training over five months to deliver the care set out in the new treatment.

(Video) Cognitive Functional Therapy Masterclass Part Two- Kjartan Vibe Fersum

“An important learning from our study was that it took quite a lot of training for physiotherapists to develop the skills and confidence to become competent to deliver the intervention at a high standard, despite the fact that many were already experienced,” Professor Hancock said. “The training included practice on real patients and receiving feedback from the trainers.”

Trial participant and retired mathematician Volker Rehbocks, a father of two, had been living with chronic back pain for at least 18 months. He first saw his GP who sent him for scans that showed degeneration and bone spurs.

His GP told him that his gardening days were over, to avoid bending and lifting, gave him anti-inflammatories and advised him to rest his back. He became progressively disabled and was struggling to do even the simplest daily activities like sitting or tying his shoelaces due to pain. He stopped doing all bending activities. Chiropractic manipulations had only given him a short-term reprieve before he eventually gave up.

The constant pain and impact on his daily life left him feeling anxious and depressed. “Chronic pain is very effective at sucking the joy out of life,” he said.

Mr Rehbocks turned to the new treatment for help – and the difference has been life-changing. It only took about six to eight months to get his life back – he was quickly sitting comfortably, tying his shoelaces, bending, gardening, cleaning, working around the house and on his car, even lifting a cylinder head out of a car engine bay. Today, his mode of transport is rarely his car, opting to ride his bike large distances at a time with no pain. “My pain has effectively gone,” he said.

Reference: “Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomised, controlled, three-arm, parallel group, phase 3, clinical trial” by Peter Kent, PhD; Prof Terry Haines, PhD; Prof Peter O’Sullivan, PhD; Prof Anne Smith, PhD; Amity Campbell, PhD; Robert Schutze, PhD; Stephanie Attwell, PhD; J P Caneiro, PhD; Robert Laird, PhD; Kieran O’Sullivan, PhD; Prof Alison McGregor, PhD; Prof Jan Hartvigsen, PhD; Den-Ching A Lee, PhD; Alistair Vickery, MBBS and Prof Mark Hancock, PhD on behalf of theRESTORE trial team, 2 May 2023, The Lancet.
DOI: 10.1016/S0140-6736(23)00441-5

(Video) Cognitive Functional Therapy with Professor Peter O'Sullivan

An international team of back pain experts, led by researchers from Curtin and Macquarie University in partnership with researchers from Monash University, the University of Limerick, Imperial College London, the University of Southern Denmark and The University of Western Australia conducted the research.

This study was funded by the National Health and Medical Research Council and Curtin University.


Cognitive Functional Therapy: Fresh Hope for Those Suffering From Chronic Back Pain? ›

In a study published in The Lancet, Cognitive Functional Therapy (CFT) showed significant improvements in chronic back pain sufferers, reducing pain intensity and disability while saving over $5,000 per person in healthcare and work productivity costs.

How do you deal with long term chronic pain? ›

How can I cope with chronic pain?
  1. Avoid smoking.
  2. Don't try to do too much. ...
  3. Eat a healthy diet.
  4. Exercise regularly.
  5. Get enough sleep.
  6. Manage your stress.
  7. Join a support group for chronic pain to learn from other people with similar conditions.
  8. Limit alcohol, which can cause more problems with sleep and pain.
Sep 1, 2021

Which treatment retrains brain to ease back pain? ›

These brain changes provide a warning for you to restrict your movement and let the body recover. But in some cases, they can cause the pain to persist long after the damage has healed. Researchers have developed a treatment called pain reprocessing therapy (PRT) to help the brain “unlearn” this kind of pain.

What is a cognitive functional therapy? ›

Cognitive Functional Therapy (CFT) is a patient-centred approach to pain management. CFT pioneered by Peter O'Sullivan, professor of Musculoskeletal Physiotherapy at Curtin University. Instead of just looking at the problem and the body part it affects, with CFT we look at you as a whole.

What is the strongest natural painkiller? ›

Endorphins are the body's natural pain relievers, and they can be as strong as many of the strongest pain relievers. Endorphins also help alleviate anxiety, stress and depression — conditions that often accompany and exacerbate chronic pain. The body produces endorphins during aerobic exercise.

What are the 10 most common conditions that have chronic pain? ›

Top Causes of Chronic Pain
  • Low back pain.
  • Arthritis, especially osteoarthritis.
  • Headache.
  • Multiple sclerosis.
  • Fibromyalgia.
  • Shingles.
  • Nerve damage (neuropathy)
Mar 9, 2011

What not to do with chronic back pain? ›

6 things you shouldn't do when your back hurts
  • Avoid bed rest. When your back hurts, lying down might seem like a good plan. ...
  • Don't sleep on your stomach. ...
  • Stop lifting heavy things or twisting your back. ...
  • Refrain from repetitive bending or stooping. ...
  • Avoid sitting for long periods of time. ...
  • Avoid certain exercises.

Does chronic back pain ever heal? ›

That said, acute back pain will usually heal itself over a few weeks. But chronic pain usually doesn't get better without medical intervention. Why? While home remedies and short-term back pain treatments are helpful, they provide temporary relief and don't address those underlying causes of chronic pain.

Is chronic back pain mental? ›

Both acute and chronic back pain can be associated with psychological distress in the form of anxiety (worries, stress) or depression (sadness, discouragement).

How do you rewire your brain to stop pain? ›

Treatments To Retrain Your Brain
  1. Cognitive Behavioural Therapy (CBT) CBT is a psychological therapy which focuses on changing negative thoughts and behaviour patterns which may be perpetuating the chronic pain cycle. ...
  2. Acceptance and Commitment Therapy (ACT) ...
  3. Graded Exposure Therapy. ...
  4. Graded Motor Imagery (GMI) ...
  5. Biofeedback.
Jul 18, 2020

How do you train your body to not feel pain? ›

Get some gentle exercise

Simple, everyday activities like walking, swimming, gardening and dancing can ease some of the pain directly by blocking pain signals to the brain. Activity also helps lessen pain by stretching stiff and tense muscles, ligaments and joints.

How do I train my brain to ignore pain? ›

Take a moment to try the following exercises to turn your mind away from the pain.
  1. Focus on Pain-Free Areas. If you're hurting from nerve pain in the feet, concentrate on what your hands can do instead. ...
  2. Think Positively. ...
  3. Distract Yourself. ...
  4. Breathe Deeply. ...
  5. Visualize the Good.
Jul 25, 2017

What are the three stages of cognitive therapy? ›

CBT is a structured, short-term, present-oriented approach to psychotherapy that helps patients modify unhelpful patterns of thinking and behavior in order to resolve current problems. CBT generally includes three broad phases: an initial phase, a middle phase, and an ending phase.

What are the three major components of cognitive therapy? ›

What Are the Main Components of Cognitive Behavioral Therapy. There are threee main components of cognitive behavioral therapy: cognitive therapy, behavioral therapy, and mindfulness-based therapies. Cognitive therapy focuses mainly on thought patterns as responsible for negative emotional and behavioral patterns.

What vitamins help with chronic pain? ›

Vitamin C, vitamin D, and magnesium are three vitamins that have shown promise for treating various chronic pain conditions. Vitamin C is thought to work best for treating complex regional pain syndrome, pain from rheumatoid arthritis and osteoarthritis, and orthopedic pain.

What is an all natural painkiller? ›

Endorphins are the body's natural painkillers. Endorphins are released by the hypothalamus and pituitary gland in response to pain or stress, this group of peptide hormones both relieves pain and creates a general feeling of well-being.

What is the brain's natural painkiller called? ›

Endorphins are hormones that are released when your body feels pain or stress. They are produced in your brain and act as messengers in your body. Endorphins are produced to help relieve pain, reduce stress and improve mood.

What is the most painful pain in the world? ›

Trigeminal neuralgia

It is one of the most painful conditions known. It causes extreme, sporadic and sudden burning pain or electric shock sensation in the face, including the eyes, lips, scalp, nose, upper jaw, forehead, and lower jaw.

What is the most excruciating pain known to humanity? ›

Trigeminal neuralgia (TN), also known as tic douloureux, is sometimes described as the most excruciating pain known to humanity. The pain typically involves the lower face and jaw, although sometimes it affects the area around the nose and above the eye.

What is the #1 most painful thing in the world? ›

The full list, in no particular order, is as follows:
  • Shingles.
  • Cluster headaches.
  • Frozen shoulder.
  • Broken bones.
  • Complex regional pain syndrome (CRPS)
  • Heart attack.
  • Slipped disc.
  • Sickle cell disease.
Sep 16, 2022

What can I take everyday for back pain? ›

NSAIDs are often the go-to drugs for back pain relief. They can be purchased over the counter (or, in higher doses, by prescription) and include ibuprofen (Advil) and naproxen (Aleve). NSAIDs help reduce pain, swelling, and inflammation in muscles and around damaged spinal discs or arthritic joints.

What helps chronic back pain fast? ›

  • stay active and try to continue with your daily activities.
  • take anti-inflammatory medicine like ibuprofen – paracetamol on its own is not recommended for back pain but it may be used with another painkiller.
  • use an ice pack (or bag of frozen peas) wrapped in a tea towel to reduce pain and swelling.

What can I take for back pain every day? ›

Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol). Sleep in a curled-up, fetal position with a pillow between your legs. If you usually sleep on your back, place a pillow or rolled towel under your knees to relieve pressure.

What is a red flag for back pain? ›

“Red flag” and “yellow flag” signs

Red flags are possible indicators of serious spinal pathology: Thoracic pain. Fever and unexplained weight loss. Bladder or bowel dysfunction.

What is the newest treatment for spinal stenosis? ›

Lumbar interspinous distraction decompression

The procedure is a type of keyhole surgery that a surgeon performs on a person under general anesthesia. One 2021 study reports a 5-year success rate of 68% for this procedure compared to a success rate of 56% for older decompression procedures.

What organ can cause lower back pain? ›

Which internal organs can cause someone to experience lower back pain?
  • Kidney problems. There are several types of kidney problems. ...
  • Appendicitis. ...
  • Ulcerative colitis. ...
  • Gallbladder dysfunction or inflammation. ...
  • Gynecological disorders. ...
  • Liver problems. ...
  • Pancreatitis. ...
  • Abdominal aorta.

What emotion is stored in lower back? ›

Lower Back = Guilt, Shame, and Unworthiness

Lower back issues often correlate with feelings of low self-worth and lack of self-acceptance. Feelings such as guilt, shame, and even sexual inadequacy or trauma can be stored here as well.

What emotion is chronic pain? ›

Individuals who experience chronic pain may find themselves feeling depressed or anxious. They will also be at risk for substance abuse and other mental health disorders. Other common emotional responses to pain can include sadness, frustration, anger or feeling misunderstood and demoralized.

What mental illness is due to chronic pain? ›

People living with chronic pain are at heightened risk for mental health problems, including depression, anxiety, and substance use disorders. Chronic pain can affect sleep, increase stress levels and contribute to depression. An estimated 35% to 45% of people with chronic pain experience depression.

Why does putting pressure on pain feel good? ›

The link between pleasure and pain is deeply rooted in our biology. For a start, all pain causes the central nervous system to release endorphins – proteins which act to block pain and work in a similar way to opiates such as morphine to induce feelings of euphoria.

What is neuroplasticity of chronic pain? ›

Neuroplasticity and chronic pain

Some neuroplastic changes occur beneath our awareness and control. One such change is being studied widely in pain medicine and is known as sensitisation. This is a phenomenon associated with changes at the nervous tissue which amplifies pain signal transmission to the brain.

Can thinking about pain cause it? ›

But unfortunately, just like pain can make you feel worse mentally, your mind can cause pain without a physical source, or make preexisting pain increase or linger. This phenomenon is called psychogenic pain, and it occurs when your pain is related to underlying psychological, emotional, or behavioral factors.

When is chronic pain too much? ›

Attending counseling, practicing mindfulness, and getting help from chronic pain support groups are all useful resources when chronic pain becomes too much. Support groups can be particularly helpful when people living with chronic pain feel as though nobody else understands their struggle.

Can you train yourself to tolerate pain? ›

Physical activity, especially aerobic exercise, can also raise pain tolerance and decrease pain perception. One study found that a moderate to vigorous cycling program significantly increased pain tolerance. Mental imagery refers to creating vivid images in your mind, and it can be useful for some in managing pain.

Why does chronic pain make you tired? ›

Often those who have a chronic pain condition will also have comorbid conditions, which can contribute to fatigue. Not giving your body all the nutrition and hydration it needs to be energized and ready to function will cause deficiencies; without the right fuel, the body will be fatigued.

What does chronic pain do to a person? ›

Regardless of its source, chronic pain can disrupt nearly all aspects of someone's life – beyond physical pain, it can impede their ability to work and participate in social and other activities like they used to, impact their relationships and cause feelings of isolation, frustration and anxiety.

What are the six steps to rewire your brain and master pain? ›

He developed a guide to help teach chronic pain patients how to rewire their brains. His method encourages patients to visualize a reduction in pain-related brain activity using the acronym, MIRROR (Motivation, Intention, Relentlessness, Reliability, Opportunity, and Restoration).

What is the first step of cognitive therapy? ›

At your first session, your therapist will typically gather information about you and ask what concerns you'd like to work on. The therapist will likely ask you about your current and past physical and emotional health to gain a deeper understanding of your situation.

What is an example of cognitive therapy? ›

What are examples of cognitive behavioral therapy? Examples of CBT techniques might include the following: Exposing yourself to situations that cause anxiety, like going into a crowded public space. Journaling about your thoughts throughout the day and recording your feelings about your thoughts.

What is Beck's cognitive therapy? ›

Beck's (1967) system of therapy is similar to Ellis's but has been most widely used in cases of depression. Cognitive therapists help clients to recognize the negative thoughts and errors in logic that cause them to be depressed.

What is the most widely used cognitive therapy method? ›

CBT is one of the most frequently used tools in the psychologist's toolbox. Though it's based on simple principles, it can have wildly positive outcomes when put into practice.

What are the 5 steps of CBT? ›

5 Easy Steps to Changing Your Thinking Using Cognitive Behavioral Therapy (CBT)
  • Step One – Make A List.
  • Step Two – Record Unproductive Thoughts.
  • Step Three – Create Replacement Thoughts.
  • Step Four – Read Your List Often.
  • Step Five – Notice And Replace.
Oct 12, 2017

What is the main goal of cognitive therapy? ›

The aim of cognitive therapy is to change the way you think about an issue that's causing concern. Negative thoughts cause self-destructive feelings and behaviours. For example, someone who thinks they are unworthy of love or respect may feel withdrawn in social situations and behave shyly.

When is CBT not appropriate? ›

it may not be suitable for people with more complex mental health needs or learning difficulties. it involves confronting your emotions and anxieties – you may experience initial periods where you're anxious or emotionally uncomfortable.

How to do Cognitive Behavioral Therapy on yourself? ›

Common behavioral techniques include:
  1. Scheduling activities that bring you enjoyment and a sense of accomplishment.
  2. Recognizing how your actions influence your thoughts and emotions.
  3. Making the best use of your time.
  4. Breaking down daunting tasks into more manageable ones.
  5. Facing your fears gradually so they diminish.
Nov 1, 2016

Which of the following disorders has cognitive therapy been found effective in treating? ›

In total, hundreds of studies have shown the effectiveness of cognitive-behavioral therapy in the treatment of numerous psychological disorders such as depression, PTSD, anxiety disorders, eating disorders, bipolar disorder, and substance abuse (Beck Institute for Cognitive Behavior Therapy, n.d.).

Can you live a long life with chronic pain? ›

The severity of long-term chronic pain that impedes daily life seems to be associated with higher mortality, researchers report.

Can you live a normal life with chronic pain? ›

The concept of living well while living with chronic pain can sound impossible, but you can thrive despite chronic pain. Living well with your chronic pain isn't just about managing your pain, but rather about finding ways to live a happy, fulfilled life in spite of your symptoms.

How do you live a good life with chronic pain? ›

In this Article
  1. Learn deep breathing or meditation to help you relax.
  2. Reduce stress in your life. ...
  3. Boost chronic pain relief with the natural endorphins from exercise.
  4. Cut back on alcohol, which can worsen sleep problems.
  5. Join a support group. ...
  6. Don't smoke. ...
  7. Track your pain level and activities every day.
Feb 14, 2023

Is chronic pain considered a disability? ›

Chronic pain syndrome can force people to retire early or severely limit their daily activities. In many cases, people have pain that is not curable. The Social Security Administration does not consider chronic pain to be a disability and chronic pain syndrome is not listed as an impairment in the Blue Book.

Has anyone recovered from chronic pain? ›

You might think this is all good in theory, but has anyone managed to actually overcome their chronic pain in 'real life'. The answer is yes: lots of people have!

What does chronic pain do to your brain? ›

Being in long term pain literally changes the structure of our brains. Chronic pain reduces the volume of gray matter in our brains. Grey matter is the area of the brain which controls learning, attention, memory, thought processes, motor control and coordination.

Does chronic pain get worse with age? ›

Aging has also been linked to an increase in the pain threshold, a decline of painful sensations, and a decrease in pain tolerance. Still, elderly patients with chronic pain show an increased risk for dementia and cognitive impairment.

Is chronic pain all mental? ›

Experiencing depression, mood fluctuations, anxiety, altered perceptions and cognition, and emotional instability, are all commonly associated with chronic pain. This is a result of the perceived stress that impacts the body on a physical and chemical level.

Does chronic pain affect personality? ›

“The study shows people with chronic pain experience disruptions in the communication between brain cells. This could lead to a change in personality through a reduction of their ability to effectively process emotions.

What is the average age of people with chronic pain? ›

The percentage of adults who had chronic pain in the past 3 months increased with age and was higher among those aged 45–64 (25.8%) and 65 and over (30.8%) compared with those aged 18–29 (8.5%) and 30–44 (14.6%) (Figure 2).

What do people with chronic pain want? ›

They are seeking connection and for someone to understand the hardships of what they're going through. Chronic pain patients often feel as if they have exhausted all their options and that things may not get better.

At what point is back pain a disability? ›

In order to be considered a 'disability,' your back pain must involve, among others, one of the following: Herniated discs. Compressed nerves. Degenerative disc disease.

Can you get disability for chronic lower back pain? ›

To qualify for Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) benefits, chronic back pain sufferers must prove they have a medically determinable impairment. Additionally, the impairment must last or be expected to last for a minimum of one year.

Is lower back pain a disability? ›

Chronic back pain can affect your ability to move, work, and live freely. According to the Centers for Disease Control and Prevention (CDC), work-related musculoskeletal disorders like back pain are the number one cause of disability during a person's working years.


1. Cognitive Functional Therapy Masterclass Part Two - Q&A with Peter O'Sullivan
(Modern Pain Podcast)
2. Hope for Healing: CBT for Chronic Pain
(Curable Health)
3. Where do I start #2. Cognitive Functional Therapy
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4. Cognitive Functional Therapy (CFT) with a sprinkle of LBP|Kjartan Fersum|Physiotutors Podcast Ep.013
5. Combining Cognitive Functional Therapy and Acceptance and Commitment Therapy with Mary Grant
(Joe Tatta, PT, DPT)
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