Fledgling Chronic Back Pain Therapy Needs More Rigorous Study

Summary: Cognitive functional therapy (CFT), a popular new therapy for the management of chronic back pain, appears to be no better than traditional therapies for pain management, a new study reports.

Source: University of New South Wales

A systematic review of relatively new treatment for chronic back pain – Cognitive Functional Therapy – has found that it is no better than traditional therapies based on evidence from past studies.

Leading the review was Mr Jack Devonshire, a PhD candidate with UNSW Sydney and Neuroscience Research Australia (NeuRA). He looked at studies of Cognitive Functional Therapy (CFT) as a treatment for chronic back pain which, for the purposes of his research, was defined as pain experienced continuously for three months or more in the region between the 12th rib and the crease of the buttocks.

CFT has been growing in popularity and gaining attention among practitioners since the first clinical trial in 2013 based on theory developed in 2005. There have been multiple trials across the world on CFT since, says Mr Devonshire.

“CFT integrates treatments that may be helpful in managing chronic lower back pain, such as pain education, exercise, and lifestyle coaching, into a model of care informed by a contemporary understanding of a person’s entire pain experience,” he says.

“The therapy aims to build upon the biopsychosocial model to provide health professionals with what we call a clear ‘clinical reasoning framework’ to tailor strategies to manage this chronic condition.”

Global interest in CFT

Despite the therapy being integrated into healthcare systems in the UK and Finland, as well as having multiple training courses online for clinicians, there hasn’t yet been a comprehensive analysis of research into this therapy.

“So we decided to perform a systematic review and meta-analysis, the highest level of evidence, to look at past studies to find out how effective the treatment is on pain, disability and safety,” Mr Devonshire says.

An effective new treatment for chronic back pain targets the nervous system

After examining all the studies that fit the research criteria, Mr Devonshire and his fellow authors found that ultimately the effectiveness of CFT remains unknown at this stage, and the group calls for future trials featuring blinded participants – those who are unaware whether the therapy being administered is actual or sham – and studies that recruit larger sample sizes.

This shows a woman clutching her back in pain
The researchers otherwise found that no adverse events were reported among patients after receiving the CFT treatment. Image is in the public domain

“The results of our study found that CFT may not reduce pain intensity and disability in people with chronic low back pain, compared to manual therapy and core exercises, either at the end of treatment or at the 12-month follow-up,” Mr Devonshire says.

“This is important as we want our exercise physiologists, physios and other health professionals who manage people with low back pain to be armed with the best available information on the available effective treatments – especially since learning to deliver CFT as a therapist is quite intensive, taking an average 106 hours of training to properly deliver the treatment.”

The researchers otherwise found that no adverse events were reported among patients after receiving the CFT treatment.

Mr Devonshire notes that certainty in the researchers’ systematic review was limited by differences between study controls, small sample sizes and a high risk of bias across all included studies, impacting the trustworthiness of the findings from these studies. The group looks forward to further research that improves current evidence via clinical trials on CFT.

About this chronic pain research news

Author: Lachlan Gilbert
Source: University of New South Wales
Contact: Lachlan Gilbert – University of New South Wales
Image: The image is in the public domain

Original Research: Closed access.
Effectiveness of cognitive functional therapy for reducing pain and disability in chronic low back pain: a systematic review and meta-analysis” by Jack Devonshire et al. Journal of Orthopaedic and Sports Physical Therapy


Effectiveness of cognitive functional therapy for reducing pain and disability in chronic low back pain: a systematic review and meta-analysis

OBJECTIVE: To evaluate whether cognitive functional therapy (CFT) is an effective treatment for adults with chronic low back pain (LBP)

DESIGN: Intervention systematic review with meta-analysis.

LITERATURE SEARCH: CENTRAL, CINAHL, MEDLINE, Embase, clinicaltrials.gov, EU clinical trials register (to March 2022).

STUDY SELECTION CRITERIA: Randomised controlled trials evaluating CFT for adults with LBP.

DATA SYNTHESIS: The primary outcomes were pain intensity and disability. Secondary outcomes were psychological status, patient satisfaction, global improvement, and adverse events. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. Random-effects meta-analysis with the Hartung-Knapp-Sidik-Jonkman adjustment was used to estimate pooled effects.

RESULTS: Fifteen trials were included (nine ongoing, one terminated), of which five provided data (n=507; n=262 CFT and n=245 control). There was very low certainty for the effectiveness of CFT compared to manual therapy plus core exercises (two studies, n=265) for reducing pain intensity (mean difference -1.02/10, 95% CI -14.75 to 12.70) and disability (mean difference -6.95/100, 95% CI -58.58 to 44.68). Narrative synthesis showed mixed results for pain intensity, disability, and secondary outcomes. No adverse events were reported. All studies were judged to be at high risk of bias.

CONCLUSION: CFT may not be more effective than other common interventions for reducing pain and disability in adults with chronic LBP. The effectiveness of CFT is very uncertain and will remain so until higher quality studies are available.

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