Does Cognitive Therapy Work For Chronic Pain?

Have you heard of Cognitive Functional Therapy (CFT)?

CFT is being promoted as an alternative to the current usual methods of treating low back pain, such as manual therapy, analgesic drugs, exercise, spinal injections, acupuncture and CBT (Cognitive Behavioural Therapy).

But does it actually work, and how effective is CFT for reducing chronic low back pain?

What is CFT?

CFT is Cognitive Functional Therapy - an approach that follows the Biopsychosocial model of pain:

CFT aims to help expose patients to movement, understand pain, and make lifestyle changes to reduce their pain and improve their function.

There's a focus on the interpersonal and social aspects of pain, and specifically including the patient's lived experiences, preferences and goals.

How Effective is CFT in Managing Pain?

A 2023 study published in the Journal of Orthopaedic and Sports Physical Therapy aimed to answer this question.

This systematic review and meta-analysis included 15 randomised control trials (RCT) evaluating the use of CFT for adults with non-specific low back pain, of which 5 provided data for the researchers. In total, 507 patients were included in these 5 trials.

The researchers looked to compare how effective CFT was in reducing pain intensity and level of disability compared to the usual conventional treatment methods, such as manual therapy, analgesic drugs, exercise, spinal injections, acupuncture and CBT.

Of the 507 included trial participants, 262 had CFT whilst 245 were in the control group undergoing the conventional treatments.

Other outcomes, such as safety, fear avoidance, pain catastrophising, anxiety, depression and patient satisfaction were also examined. 

• Pain Intensity Outcomes: No significant clinical difference between the 2 groups at the end of the study or after 6 months, 12 months and 3 years.
• Disability Outcomes: No significant clinical difference between the 2 groups at the end of the study. At both 6 and 12 months, 1 of the 5 studies reported a significant difference favouring CFT, After 3 years, 1 study reported a significant difference favouring CFT.
• Safety Outcomes: Of the 3 trials that recorded safety, there were no adverse effects noted.

The researchers noted that all the included studies had a high risk of bias. Therefore the results of these studies must be read with caution.

What Can We Conclude From This Study?

The researchers concluded from their review and meta-analysis that the effectiveness of CFT for treating non-specific low back pain must be considered uncertain until more larger and higher quality studies are published.

It does appear that the medical and health sectors have very mixed outcomes when treating patients with chronic pain, and there isn't one single protocol that currently works better than others in reducing pain.

I think this highlights that chronic pain is complex, differs from person to person and there are many contributing factors that need to be considered.

Unfortunately conventional medical and health practices typically involve treating 1 symptom at a time using a standardised protocol - essentially like a game of whack-a-mole and equally hit and miss!

Your shoulder starts hurting so you see a physiotherapist. If that doesn't work you progress to medicating the shoulder, and the end game is surgery.

Or you put your back out, so you get your spine manipulated and have a sports massage. Then if the pain persists you get referred for an MRI, followed by an injection to 'cure' the pathology seen on the scan. But 6 months later, your back is still twinging and you've stopped exercising because you need to 'take care of your dodgy back'.

Does this sound like a familiar story? Maybe it's happened to you, or someone you know.

I've spent a decade and many 1000's of £££'s learning to understand pain and how to relieve painful movement, both in myself, my class participants and 1:1 clients.

That significant investment of time and finances has enabled me to create The Befriend Your Body (BYB) Method, a 4 pillar framework to help you find your pain-free body.

Unlike conventional treatment methods that involve a specialist in 1 field, eg. a physiotherapist treating your muscles, a psychologist changing your behaviour or a surgeon repairing your joint, the 4 pillars of The BYB Method encompass many different disciplines.

This approach reflects my diverse interests, including pain science, the musculoskeletal system, movement, cell health, physiology, the immune system, Yoga, trauma, Polyvagal Theory of safety, neuroscience, heart coherence, mindset, neurodiversity, human design and energy healing / clearing.

The 4x pillars of The BYB Method are:

1. Body
2. Breath
3. Be
4. Bond

These 4 pillars take care of :

• Muscles
• Nervous system regulation
• Sensory awareness (self awareness)
• Motor control
• Safety (fear avoidance, catastrophising)
• Physiology
• Emotional state 
• Social connection
• Coping strategies for pain management at home

The BYB Method is not a cookie cutter approach. The 4x pillars provide a framework, but everyone is encouraged to explore their own personal experiences of sensations, thoughts and movement. 

This builds self agency, self awareness and, eventually, self confidence in your body - so important for reducing fear avoidance and catastrophising thoughts that increase tension and prolong pain.

Once you know the patterns that lead to tension and pain in your body, you can start to undo them and create new, more helpful patterns. 

[NB} The link to the study is at the bottom of the blog.

NEXT STEPS

Look out for a free E-guide "How To Relieve Back Pain & Muscle Tension in Just 10 minutes a Day" that I'll be sending to everyone on my mailing list soon.

I'm planning new weekend workshop retreats that will introduce you to the fundamental movement explorations of The BYB Method, whilst also including the relaxing ambience of a mind-body retreat with guided meditations and a sound bath experience.

• Book into a Stretch, Yoga or Pilates class with me - these are a good introduction to The BYB Method and take the first steps to your pain-free body.
• Attend a mind-body retreat - these are deeply relaxing, fun, social small group experiences typically held in various locations within easy reach of Worthing, West Sussex. The next retreats are "Rest & Reflect" half-day winter retreat on Sunday 3rd December (FULL) and "Sun & Moon" mini retreat on Sunday 17th December (last 4x spaces left). Click HERE to read more about them,
• Subscribe HERE to receive "The Movement Chronicle", a weekly e-newsletter delivering mobility and pain reduction tips directly into your inbox every Monday morning,

To find out more about my classes and retreats, or to join my email list you can contact me via any of these channels:

• Email at norma.pearson1@ntlworld.com
• DM me on Facebook Messenger 
• WhatsApp message to 07801 867361.

Study Link

Effectiveness of Cognitive Functional Therapy for Reducing Pain and Disability in Chronic Low Back Pain: A Systematic Review and Meta-analysisJack J. Devonshire, Michael A. Wewege, Harrison J. Hansford, Hasibe A. Odemis, Benedict M. Wand, Matthew D. Jones, and James H. McAuleyJournal of Orthopaedic & Sports Physical Therapy 2023 53:5, 244-285