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Major good news study for back pain (which validates my career)

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

An impressive new good news back pain study in The Lancet broadly validates advice I’ve been giving for many years about all kinds of chronic pain, mainly:

  • knowledge is an active ingredient, and
  • so is building confidence with movement and exercise (but not exercising to “correct” biomechanical glitches, which tend to be fanciful).

These things are inherently worthwhile even if they aren’t actually therapeutic, so they’ve always got that going for them no matter what, which is partly why I’ve been willing to sing that tune for so long with so few directly relevant citations to back me up.

But this robust new trial reports that those things are therapeutic. In a pretty big way. Not a too-good-to-be-true way, but even just ordinary good is unusual for trials of back pain treatments. (Rather famously, “nothing works,” e.g. see Machado’s classic party-pooper review from 2009.) And this is a well-built trial, conducted by researchers with a great track record, in one of the finest journals. Not many people would hold it against me if I just, you know, believed it.

Update: Several months later, I wrote a great deal about this paper. Read the in-depth analysis. It’s also covered in my back pain book.

 No study is perfect, though! And the more a study tells me what I want to hear, the more wary I need to be of celebrating it prematurely, and this is a whopper of an example. Kent et al. haven’t just validated my advice, they’ve validated my career and my business, my whole health education strategy for twenty years now. So I’m not exactly in the best position to evaluate this one critically. 😜 Which is exactly why I must actually try to overcome that bias. I will make an earnest effort to analyze this paper critically.

And how does one do that? How do you critically analyze science you want to love?

  1. ACT like you hate it. Nitpick like you are impossible to please. Role-play cynicism.

  2. ASK people who actually do hate it — or at least have more concerns than you. Ask “who disagrees and why?

But … later. For now, I just want cheer for what sure seems like unusually good news about treating back pain (and very likely other kinds of chronic pain too). Basically the study shows great outcomes for patients doing “Cognitive Functional Therapy” (CFT, not CBT, that’s different): modest but clear reductions in pain, and really good improvements in pain-related activity limitations.

How can you learn more about CFT? I’m glad you asked, because this study has a website for that — — which promotes and splains both the study and CFT itself. Why a website? I expect it has something to do with that whole “knowledge is an active ingredient” thing. The trial shows that informed confidence is valuable, so… preach it!

P.S. I would love to see that website stick around long term, but I’m not optimistic. I’ve been doing an overdue round of fixing broken links on, and it is craaaazy how many there are, how often websites vanish, all the cool resources I’ve linked to over the years that lasted a year, maybe three … but very rarely longer. Websites do not run themselves, and they are doomed without active stewardship. Which is why I sell e-books and memberships! I don’t want to become one of those vanished resources.

PainSci Member Login » Submit your email to unlock member content. If you can’t remember/access your registration email, please contact me. ~ Paul Ingraham, PainSci Publisher