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Promising trial of cognitive functional therapy for low back pain


Tags: treatment, mind, neck, back pain, head/neck, spine, pain problems

Five articles on PainSci cite Vibe-Fersum 2013: (1) When to Worry About Low Back Pain(2) Complete Guide to Low Back Pain(3) The Complete Guide to Neck Pain & Cricks(4) Pain is Weird(5) The Mind Game in Low Back Pain

PainSci summary of Vibe-Fersum 2013: ?This page is one of thousands in the bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible.

Statistically and clinically significant results for a back pain treatment? Pinch me!

Classification-based cognitive functional therapy (CB-CFT or just CFT) for low back pain is a “body/mind approach to understanding and managing this complex problem” that “targets the beliefs, fears and associated behaviours” of patients — what I have called the “confidence cure” for many years. The big idea of CFT is that back pain does not necessarily have anything to do with a damaged or degenerated back, and the cycle of pain and disability can be broken by easing patient fears and anxieties.

CFT was tested on 62 patients with moderate back pain, and compared to 59 who were treated with manual therapy and exercise. Three months and a year later, the CFT group was much better off: a 13-point boost on a 100-point disability scale, and 3 points on a 10-point pain scale. Those are not amazing results, but enough to be considered clinically significant, and they beat manual therapy and exercise handily (those patients improved by only 5.5 and 1.5 points on the same scales). CFT was “more effective at reducing pain, disability, fear beliefs, mood and sick leave at long-term follow-up than MT-EX.” As the authors put it for, “Disabling back pain can change for the better with a different narrative and coping strategies.”

There were some blemishes on the study methods, but nothing dire; its results can be safely regarded as “promising” while we wait for replication from bigger studies.

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

BACKGROUND: Non-specific chronic low back pain disorders have been proven resistant to change, and there is still a lack of clear evidence for one specific treatment intervention being superior to another.

METHODS: This randomized controlled trial aimed to investigate the efficacy of a behavioural approach to management, classification-based cognitive functional therapy, compared with traditional manual therapy and exercise. Linear mixed models were used to estimate the group differences in treatment effects. Primary outcomes at 12-month follow-up were Oswestry Disability Index and pain intensity, measured with numeric rating scale. Inclusion criteria were as follows: age between 18 and 65 years, diagnosed with non-specific chronic low back pain for>3 months, localized pain from T12 to gluteal folds, provoked with postures, movement and activities. Oswestry Disability Index had to be>14% and pain intensity last 14 days>2/10. A total of 121 patients were randomized to either classification-based cognitive functional therapy group n = 62) or manual therapy and exercise group (n > = 59).

RESULTS: The classification-based cognitive functional therapy group displayed significantly superior outcomes to the manual therapy and exercise group, both statistically (p < 0.001) and clinically. For Oswestry Disability Index, the classification-based cognitive functional therapy group improved by 13.7 points, and the manual therapy and exercise group by 5.5 points. For pain intensity, the classification-based cognitive functional therapy improved by 3.2 points, and the manual therapy and exercise group by 1.5 points.

CONCLUSIONS: The classification-based cognitive functional therapy produced superior outcomes for non-specific chronic low back pain compared with traditional manual therapy and exercise.

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Specifically regarding Vibe-Fersum 2013:

This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights: