Summary: Researchers warn there is not enough data yet to back wide use of emerging non-pharmacological treatments for chronic low back pain, like cognitive functional therapy (CFT). A recent review failed to confirm that CFT helps. Chronic low back pain is common and hits most people at some point. But it is still hard to treat. So managing chronic low back pain takes a plan with many parts. Doctors are also testing many other drug-free ways to treat it.
Low back pain is one of the top causes of chronic pain. An estimated 80% of adults will have low back pain at some point. At any given time, 15%-30% of older adults have low back pain.
But for many adults, low back pain becomes chronic, and nothing seems to help. The pain lasts for months or even years. It can lead to real disability.
Chronic pain is hard to treat because it is poorly understood. It is not just caused by a back injury or wear and tear. In many cases, the cause of low back pain may not be in the spine at all. For example, people with depression are more likely to have chronic low back pain.
This explains why antidepressants work in many cases of chronic low back pain. These drugs boost the effect of painkillers. They also act on the brain and spinal cord. In the same way, talk therapies may also help improve quality of life for people with chronic low back pain.
Many drug-free treatments for chronic low back pain are now popular. But researchers warn that many of them have not been tested in clinical studies, even though they are widely used. One example is cognitive functional therapy (CFT), which doctors use more and more.
Cognitive functional therapy (CFT) is a way to manage low back pain. It treats the physical side of pain. It also treats the thoughts, feelings and life stresses that can keep pain going. CFT is a whole-person approach. It combines mental and behavior strategies with movement and functional exercises.
CFT starts from the idea that many things shape low back pain. These include beliefs, emotions, behavior and social life. They also include physical factors like muscle imbalance, stiff or faulty joints and how a person moves. CFT aims to treat all of these together to get lasting pain relief and better function.
In CFT, a person’s beliefs, thoughts and feelings about pain matter. They shape how much the pain hurts and how well the person copes. Patients learn to spot and challenge unhelpful beliefs about their pain. They build more helpful ways of thinking. This may include lessons on how pain works, building confidence, and seeing their pain in a new way.
CFT also works on behavior, such as how a person moves and stays active. Movement and functional exercises work on physical weak spots and build capacity. They help people slowly return to normal activities and move in healthier ways. CFT matches exercise to each person and adds it step by step, based on what that person needs and can do.
Another key part of CFT is dealing with stress, fear and social life. This may mean teaching stress control and relaxation. It may also mean working on barriers to recovery, such as avoiding movement out of fear or coping in ways that backfire.
As CFT grows more popular, doctors are spending a lot of time learning it. But some experts doubt this approach to lower back pain. They say there is not enough evidence to support its wide use.
So researchers recently did the largest study yet on whether CFT works for low back pain. They ran a full systematic review that included 15 clinical studies. But only five of these were good quality. The researchers concluded there is not enough data to confirm that CFT helps low back pain. So its wide use is not justified until more studies are done.
Frequently asked questions
What is cognitive functional therapy for back pain?
Cognitive functional therapy, or CFT, treats low back pain as more than a physical problem. It pairs movement and exercise with work on the beliefs, fears, emotions and stress that keep pain going. Patients learn how pain works. They challenge unhelpful thoughts about their pain. They build back normal activity step by step, with exercise matched to what each person can do.
Does cognitive functional therapy work for chronic low back pain?
The evidence is not there yet. The largest review so far looked at 15 clinical studies, and only five were good quality. The researchers concluded there is not enough data to confirm that CFT helps low back pain. So its wide use is not justified until more studies are done. Many other popular drug-free therapies have not been tested in clinical studies either.
What causes constant low back pain?
It is not always an injury or wear and tear in the spine. In many cases, the cause of chronic low back pain is not in the spine at all. Depression, for example, makes chronic low back pain more likely. That is why back pain that lasts for months or years needs a plan with many parts, not one treatment aimed at the spine.
How common is low back pain?
Very common. An estimated 80% of adults will have low back pain at some point in their lives. At any given time, 15% to 30% of older adults are dealing with it. For many people it becomes chronic. Nothing seems to help, the pain lasts months or even years, and it can lead to real disability.
Why are antidepressants used for chronic back pain?
Because chronic back pain is tied to the nervous system and to mood, not just to the spine. Antidepressants help in many cases of chronic low back pain. They make painkillers work better. They also act directly on the brain and spinal cord. Talk therapies can also improve quality of life for people with long-term back pain.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
