Short course of psychotherapy relieves lower back pain for three years

A short-term course of a type of psychotherapy was three times more effective at relieving chronic lower back pain than standard treatments, even years later.

Cognitive functional therapy (CFT) provides people with personalised programmes that teach them to understand and manage their pain through movement and lifestyle changes. In 2023, researchers found it relieved chronic lower back pain for at least a year after just eight sessions.

Now, the researchers have found those sessions continued to bring about relief three years later – tripling the improvement in pain and its associated disability levels compared with the care people were already on, such as painkillers, physical therapy or therapeutic massage.

“It seems to produce a lasting difference in patients who are very disabled from back pain, many of whom were – for all practical purposes – treatment resistant,” says Jan Hartvigsen at the University of Southern Denmark.

Back pain of any kind is a leading cause of disability globally, with treatments often providing only mild, short-term relief. In the 2023 trial, Hartvigsen and his colleagues recruited 492 people with chronic lower back pain, defined as rating at least 4 on a pain scale of 0 to 10 and that had been moderately to severely limiting their physical activity for three months or more.

The researchers had one-third of the participants continue with their typical care routine. The other two-thirds stopped their regular care to engage in seven CFT sessions over 12 weeks, with a final session at 26 weeks.

During those sessions, physiotherapists with extensive training in how to deliver this psychotherapy examined each individual’s posture, thoughts about pain, emotions and lifestyle factors. They aimed to help the participants view their pain differently, retrain their movement patterns and control strategies and adopt healthier diets, rest strategies, stress management and exercise plans.

“Many people with chronic pain become afraid of using their body,” says Hartvigsen. “They’re not crazy and it isn’t all in their heads. But their behaviour, their beliefs and their nervous systems have become so adapted and used to these pain behaviours that they need someone who can form a strong therapeutic alliance with them.”

Half of the participants in the CFT group also had biofeedback, a sensor-based technique that allows them to track their movement patterns in real time to help retrain their posture and motion.

At one year, both pain intensity and disability levels – measured according to the Roland Morris Disability Questionnaire – improved about three to four times as much in the CFT groups compared with those receiving usual care. Biofeedback only slightly increased the efficacy of the CFT.

In the new three-year follow-up, Hartvigsen team’s obtained updated feedback from 312 of the participants, who were evenly distributed across the treatment groups.

They found those who received CFT still had a nearly three-fold improvement in both pain and disability compared with the usual care group. Plus, about three times as many people in the CFT groups had disability scores so low on the questionnaire their pain was no longer considered functionally disabling.

But the participants were all free to seek additional care after the first year, which was not recorded.