Summary: Chronic low back pain is quite common and affects most people sometimes in their life. However, it still remains challenging to treat. Thus, managing chronic low back pain requires a multidimensional approach. Additionally, doctors are also testing many other non-pharmacological approaches to managing the condition, like cognitive functional therapy (CFT). However, researchers warn that, at present, there is insufficient data to support the widespread use of such treatments. Thus, for example, one of the recent systemic reviews failed to confirm the benefits of CFT in chronic low back pain.
Low back pain is among the leading causes of chronic pain. An estimated 80% of adults will experience low back pain sometimes in their life. At any given time, 15%-30% of older adults are experiencing low back pain.
However, low back pain in many adults becomes a chronic issue, and nothing seems to help. They continue to experience low back pain for months and even years, resulting in a significant disability.
Chronic pain is challenging to treat, as it is a poorly understood condition. It is not just caused by some low back trauma or due to degenerative processes. In many cases, the cause of low back pain may not be in the spine. Thus, for example, those living with depression are more likely to experience chronic low back pain.
This explains why anti-depressants are effective in many chronic low back pain cases. Such drugs not only potentiate the activity of painkillers but also act on the central nervous system. Similarly, various psychological therapies may also help enhance the quality of life of people living with chronic low back pain.
Currently, many non-pharmacological treatments for chronic low back pain are also being popularized. However, researchers warn that many such therapies though used extensively, have not been tested in clinical studies. For example, in recent years, doctors have been increasingly using cognitive functional therapy (CFT).
Cognitive functional therapy (CFT) is an approach to managing low back pain that focuses on addressing the physical aspects of pain and the cognitive and psychosocial factors that can contribute to its persistence. CFT is a holistic and multidimensional approach that combines cognitive and behavioral strategies with movement and functional exercises.
CFT is based on the understanding that low back pain is often influenced by various factors, including beliefs, emotions, behavior, and social context, in addition to physical factors such as muscle imbalances, joint dysfunction, and movement patterns. Therefore, CFT aims to address these different factors comprehensively to achieve long-term pain relief and improved function.
In CFT, the individual’s beliefs, thoughts, and emotions about pain are considered important factors influencing their pain experience and ability to cope with it. The approach involves helping individuals identify and challenge unhelpful beliefs or thought patterns related to their pain and developing more positive and adaptive cognitive strategies. This may include education about pain science, promoting self-efficacy, and helping individuals reframe their pain perception.
CFT also involves addressing behavioral factors such as movement and activity patterns. Movement and functional exercises address physical impairments and improve functional capacity, helping individuals gradually resume their normal activities and develop healthier movement patterns. CFT emphasizes an individualized and graded approach to exercise, taking into consideration the person’s specific needs and capabilities.
Another key aspect of CFT is addressing psychosocial factors such as stress, fear, and social context. This may involve addressing stress management techniques, promoting relaxation strategies, and addressing any psychosocial barriers to recovery, such as fear avoidance behaviors or maladaptive coping strategies.
As CFT is becoming increasingly popular, doctors are spending much time learning the therapy. However, some experts are skeptical about this treatment approach to lower back pain. They say that there is insufficient evidence to support its widespread use.
Thus, recently, researchers carried out the most extensive study regarding the efficacy of CFT in low back pain. They did a comprehensive systemic review, which included 15 clinical studies. However, out of these, only five were of good quality. In this systemic review, researchers concluded that there is insufficient data to confirm the benefit of CFT in low back pain. Hence, its widespread use is unjustified until more studies are done.1