Studies found that cognitive functional therapy was more effective than usual care at improving levels of activity among people with low back pain
Using a form of psychotherapy for low back pain can effectively reduce disability due to the condition by up to three years, a major clinical trial has found.
Marked by unpredictable recurrences or pain flare-ups, an estimated 619 million people live with low back pain (LBP), making it the leading cause of disability worldwide. LBP is often associated with loss of work productivity, often leading to a significant economic burden on individuals and on societies.
Previous research found that cognitive functional therapy (CFT) was more effective than usual care at improving self-reported physical activity participation in those with low back pain up to one year.
This latest trial, published in the Lancet, is the first to show that these effects are sustained for up to three years.
The RESTORE randomised controlled trial included 492 patients with chronic low back pain in Australia. They 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).
While those who received CFT and CFT plus biofeedback saw improvements in their physical activity participation over usual care, the difference between those receiving CFT-only and CFT plus biofeedback at three years were small and not significant. These findings were is also consistent with results seen at three-months and one year into the trial.
The authors believe the current trial 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.
“Treatment sessions of CFT produced sustained effects at three years for people with chronic disabling low back pain,” the authors wrote.
“These long-term effects are novel and provide the opportunity to markedly reduce the effect of chronic back pain if the intervention can be widely implemented.
“Implementation requires scaling up of clinician training to increase accessibility and replication studies in diverse health-care systems.”
RESTORE trial participant Alison Thompson who had to quit her job because of her low back pain. The amateur triathlete got to the point where attempting to put on her running shorts would trigger severe pain.
However, after examining her back, her doctor couldn’t see any issue. That is when she tried CFT.
“Key to remedying the pain was to actually reduce the nervous system response and to quieten down the nervous system. Meditation became a part of my everyday life,” she said.
“The key differences between the approaches of the people I saw to start with, and the new physio, was that it was more of a whole-of-body approach. This physio understood where the pain was properly coming from – it wasn’t coming from a physical issue, it was coming from more of a response to the anxieties and stresses in my life.”
