Cognitive-functional therapy aims to release the fear of movement and has helped many people with long‑standing fear find relief from lower back pain. Researchers from Curtin University in Australia discussed this approach in detail during a recent presentation.
Each year, about 40% of adults experience some form of lower back pain, spanning teenagers to older adults. While most recover, roughly 20% of people continue to suffer with persistent pain for longer than three months, a condition often labeled chronic low back pain.
There is a widespread belief that chronic low back pain arises mainly from wear-and-tear damage to spinal tissues, such as disc degeneration. In reality, signs like herniated discs or arthritis are common in people who do not experience pain. MRI findings can also alarm patients and encourage avoidance of activity. When people think pain reflects ongoing tissue damage, fear and anxiety can actually amplify the pain and slow recovery.
The authors evaluated 492 participants and found that chronic low back pain can respond positively to cognitive-functional therapy. This approach blends psychotherapy with movement-based therapy to help individuals understand the personal factors that contribute to pain and to reduce fear of movement. Sessions are designed to account for sleep patterns, rest, and daily activity levels as part of a broader plan for pain management.
Over six months, 18 physiotherapists in the major Australian cities of Perth and Sydney were trained in cognitive-functional therapy. Patients treated by these professionals showed meaningful and lasting improvements in physical function and reductions in pain compared with those receiving standard medical care, a difference that persisted over time.
The benefits lasted up to 12 months, a notably longer period than many conventional interventions, which often include standard exercise or purely psychological approaches. About 80% of participants expressed satisfaction or high satisfaction with the treatment, versus 19% in the usual-care group, indicating a strong perceived value among recipients.
Participants had endured pain for an average of four years and had tried a variety of other treatments before joining the study. The findings were published in a major medical journal, and the authors emphasize that cognitive-functional therapy can be considered when serious causes of back pain have been ruled out and a comprehensive assessment supports its use. This aligns with a growing emphasis on addressing pain through a biopsychosocial lens rather than by focusing solely on tissue damage. — Lancet
Experts note that while this therapy shows promise, it should be integrated with careful clinical evaluation. Effective pain management often hinges on addressing sleep quality, stress levels, physical activity, and daily routines, all of which influence how pain is perceived and managed. In this light, cognitive-functional therapy offers a practical framework to reframe pain and empower patients to resume meaningful activity with confidence. — Lancet
For readers seeking comprehensive pain relief strategies, the study underscores the importance of multidisciplinary care that includes physical therapy, psychology, and lifestyle modification. When guided by trained professionals, patients can regain function, reduce reliance on medications, and re-engage with daily life more fully. While more research is needed to confirm long-term outcomes across diverse populations, the current findings provide a solid basis for considering cognitive-functional therapy as part of a broader, evidence-based plan for chronic back pain. — Lancet
As a practical takeaway, clinicians are encouraged to screen for fear of movement and maladaptive beliefs about pain early in the treatment process. By doing so, care teams can tailor interventions that address both physiological signals and cognitive reactions, helping patients move toward healthier, more active lives. Through this integrated approach, the fear that often perpetuates chronic pain may lessen, opening pathways to recovery and improved quality of life. — Lancet