Australian study finds lasting relief for back pain through cognitive functional therapy

Australian research has shown that a personalized program that helps people with chronic, disabling low back pain better understand their condition and take charge of its management produces large benefits that are sustained over three years.

In the RESTORE trial, conducted at centres in Sydney and Perth, a seven-session program of cognitive functional therapy (CFT) delivered by specially trained physiotherapists significantly reduced people's back pain and improved their function, compared with usual care.

Data just published in medical journal The Lancet Rheumatology show these improvements were largely maintained over three years of follow-up.

The persistent effect of CFT over time is a new and very important finding, says lead author Professor Mark Hancock, Professor of Physiotherapy at Macquarie University.

This the first large, high-quality study investigating the long-term impact of CFT, and shows that it's effective and remains effective.

In fact, our previous systematic review shows there are relatively few long-term outcome studies of other treatments for chronic low back pain."

Professor Mark Hancock, Professor of Physiotherapy, Macquarie University

Around 4 million Australians – one in six – live with back problems, making them the third leading cause of disease burden overall, according to the Australian Institute of Health and Welfare.

The development of CFT and its use in the RESTORE trial stemmed from what the researchers and clinicians describe as a "biopsychosocial" model of treatment, which targets the physical, psychological and social factors involved in chronic back pain and the disability it causes.

"An episode of back pain can understandably cause anxiety and fear, leading people to overprotect their body and avoid usual movements," says study co-author Professor Peter O'Sullivan, John Curtin Distinguished Professor in the School of Allied Health Sciences at Curtin University.

"When this persists, it can set up a vicious cycle of pain sensitivity and limitation of activities," he explains.

"CFT is about putting people in the driver's seat: giving them the skills to manage their pain, and building their confidence to move, get active and back to living."

Back pain is the number one cause of disability globally, says Professor Hancock, and is so common and disruptive that an intervention producing lasting reductions in pain and dysfunction offers potential for a major human and economic impact.

In Australia, an estimated $3.4 billion was spent treating and managing back problems, representing 2.2% of total health system expenditure in 2020-21.

"Things like massage, manipulation and medication can provide short-term symptom control but in the longer term, mind and body approaches that give patients the skills and confidence to self-manage, are much more effective," says Professor Hancock.

"Our findings suggest the massive burden of low back pain could be markedly reduced if health policies supported widespread implementation of high-value, low-risk and sustained interventions like CFT, instead of less effective, short-term and potentially harmful interventions like opioids or surgery."