Rethinking Persistent Low Back Pain: A Modern, Evidence-Based Framework
If you're dealing with persistent low back pain, you know it affects more than just your back. It can influence how you move, what you feel confident doing, and your overall quality of life. A modern, evidence-based approach called Cognitive Functional Therapy (CFT) offers a powerful framework for change by addressing the complex nature of your pain in a personalized way.
But does it work? According to the highest level of scientific evidence, the answer is a resounding yes.
For many individuals, the experience of persistent low back pain is a frustrating cycle of recurring episodes, failed interventions, and growing uncertainty. The conventional medical approach has traditionally focused on identifying a specific anatomical fault through imaging studies like MRI. While crucial for ruling out serious pathology, this structural model has proven insufficient for the vast majority of persistent pain cases (O'Sullivan et al., 2019).
This is because a growing body of scientific evidence demonstrates a poor correlation between findings on imaging and a person's actual pain experience. Degenerative changes are a normal part of the aging process and are commonly found in individuals who have never experienced back pain. When these findings are presented as the primary cause of suffering, it can inadvertently create fear and the belief that the spine is fragile. This mindset can lead to a cascade of unhelpful protective behaviors, contributing to a self-perpetuating cycle of pain and disability (O'Sullivan et al., 2019).
A Comprehensive View: The Biopsychosocial Nature of Pain
A modern understanding views persistent pain not simply as a signal of ongoing tissue damage, but as a complex output of the nervous system. It's an experience influenced by an interplay of factors unique to each individual. This is known as the biopsychosocial framework (O'Sullivan et al., 2019).
This framework acknowledges that to effectively address persistent pain, we must consider the whole person:
Biological Factors: This includes the sensitivity of the nervous system and body tissues, as well as physical factors like guarded movement patterns and muscle tension. While intended to be protective, these patterns can overload tissues and perpetuate the pain experience.
Psychological Factors: Our thoughts, beliefs, and emotional states profoundly impact pain perception. Beliefs like "my back is damaged" can lead to fear of movement. This fear, along with stress and anxiety, heightens the sensitivity of the nervous system, effectively "turning up the volume" on pain signals.
Social and Lifestyle Factors: An individual's environment and daily habits are critically important. Factors such as work-related stress, poor sleep quality, or a sedentary lifestyle can all contribute to a state of increased nervous system sensitivity.
These elements interact to create a feedback loop: pain leads to fear, which leads to avoidance, which leads to deconditioning and more pain, reinforcing the initial fear. The clinical task is to interrupt this cycle.
A Targeted, Evidence-Based Approach: Cognitive Functional Therapy (CFT)
Cognitive Functional Therapy (CFT) is an integrated framework for managing disabling low back pain that directly addresses this complexity. It's an active, person-centered approach that empowers individuals by targeting the specific factors contributing to their pain and disability (O'Sullivan et al., 2019).
The effectiveness of this approach is no longer theoretical. The most comprehensive systematic review and meta-analysis to date has synthesized the highest level of medical evidence and found that CFT is a promising and effective intervention for people with chronic low back pain (Thiveos et al., 2024).
The process is a partnership between the therapist and the patient. Our clinical philosophy is grounded in this modern, evidence-based understanding of pain. We are committed to the high-fidelity application of Cognitive Functional Therapy because we've seen the transformative results it can produce.
Our goal is to partner with you, empowering you with the knowledge, skills, and confidence to become the primary manager of your health. We want to help you move beyond your pain and participate fully in the activities you value most.
Contact us today at Neev Physical Therapy and Wellness to schedule a virtual or in-clinic appointment. We're here to help you move better, feel stronger, and live fully.
References
O’Sullivan, P. B., Caneiro, J. P., O’Keeffe, M., Smith, A., Dankaerts, W., Fersum, K., & O’Sullivan, K. (2018). Cognitive Functional Therapy: An Integrated Behavioral Approach for the Targeted Management of Disabling Low Back Pain. Physical Therapy, 98(5), 408–423.
Thiveos, L., Kent, P., Pocovi, N. C., O’Sullivan, P., & Hancock, M. J. (2024). Cognitive Functional Therapy for Chronic Low Back Pain: A Systematic Review and Meta-Analysis. Journal of Orthopaedic & Sports Physical Therapy. Published online ahead of print.