Back Pain Relief: Talking Therapy Shows Promising Results

New Study Highlights Cognitive Functional Therapy’s Impact

Chronic back pain, often starting as a mild ache, could find relief through a novel talking therapy. A recent study published in The Lancet Rheumatology investigated the effectiveness of cognitive functional therapy (CFT) in addressing the root causes of persistent lower back discomfort.

Therapy Targets Pain Perception

CFT aims to reframe how individuals perceive and react to their pain. Researchers involved over 1,000 participants, dividing them into three groups: standard care, CFT alone, and CFT combined with biofeedback, a technique to help control bodily functions. Both CFT-based approaches significantly reduced activity limitations compared to standard treatments.

Understanding Common Back Pain Causes

Muscle strains and ligament sprains are frequent culprits, often stemming from sudden movements or returning to activity after a break. Advanced practice physiotherapist **Sam Bhide** notes, “The first episode of back pain is usually related to a sudden injury.” Diagnosis typically involves physical assessments by physiotherapists or doctors, including movement and muscle tests.

Physiotherapist **Mick Thacker** emphasizes the importance of staying active. “In the majority of cases, that’s actually enough to indicate potentially the best way to manage people’s pain,” he states, advising exercise that respects pain levels.

Degenerative Conditions and Bone Health

Osteoarthritis, affecting the spine’s facet joints, can lead to age-related changes known as spondylosis. **Thacker** explains that individuals with spondylosis often experience morning stiffness that eases during the day, with pain worsening into the evening.

Osteoporosis, while not typically painful until a fracture occurs, can cause long-term spinal pain. **Thacker** points out that this condition, characterized by reduced bone mineral density, is more common in women post-menopause. Gentle, load-bearing exercise is recommended for bone health, with caution due to potential fragility.

Disc Issues and Nerve Compression

Bulging or ruptured discs, though less common, can be significant pain generators. **Thacker** explains that a ruptured disc can cause inflammation, an immune response in surrounding tissues that may take weeks to resolve. Large disc bulges can also compress spinal nerves, including the cauda equina, potentially affecting bowel and bladder function.

“The problem with large disc bulges is that it can actually compress the nervous tissue of the spine, and that can be quite serious if it compresses what’s called your cauda equina… So, the disturbance of bowel and bladder function can be associated with back pain. That can be a medical emergency because if you don’t seek care for that quickly, it can be a long-standing problem and you can become incontinent,” warns **Thacker**.

Psychological Factors Amplify Pain

Psychosocial factors, such as stress, can amplify existing pain. **Thacker** identifies work-related pressure and workloads as potential contributors to nervous system changes that increase susceptibility to back pain. “Also, if you’ve already got existing pain, factors like stress will always make that pain worse. So, unless you address those factors, people don’t tend to respond well to the treatments that are advocated.”

**Bhide** agrees, advocating for integrated physical and psychological approaches. “In combined psychological and physical programs, people do exercises but also see a psychologist who gives their input and then talks about pain education and gives them a little bit more understanding of how to manage it better,” he explains, adding that this is often the most effective strategy for chronic pain.