Cognitive Functional Therapy: New hope for low back pain sufferers

Chronic low back pain (LBP) is a common complaint of adults of all ages, genders and nationalities. Yet pain in the lumbar region is only rarely associated with trauma or pathology. Most chronic LBP is non-specific in nature, meaning there is no evidence of structural or mechanical dysfunction.

For people who suffer from chronic LBP, the inability of medical practitioners to identify the underlying cause, and the failure of costly surgical interventions, can be highly frustrating. Yet, out of desperation to eliminate pain, many people who underwent a failed surgery for LBP go back for subsequent surgeries, even though the results do not alleviate their pain.

Moreover, a herniated disc or bone spur detected on an Xray or MRI does not necessarily indicate the need for surgery. The truth is, some degree of degeneration of the spine is common as we age, and many people whose imaging results indicate structural damage do not experience back pain at all.

Most of us who live in Western countries have adopted a broad cultural view that pain is bad, and must be treated. We feel a certain sense of entitlement to a pain-free life, and we expect medical practitioners to fulfill our expectations. In fact, many of us fear pain, and at the slightest twinge, our first impulse is to immobilize the painful area to protect it from further damage.

In the case of the spine, we have been conditioned to believe that our spinal columns are fragile structures that must be protected at all costs. At the first sensation of back pain, we take to our beds, call out from work, and cancel our social obligations. However, new inroads in research are rapidly debunking the notions that the spine is delicate, and that back pain is a signal to stop moving.

Most people believe pain to be a signal that something is structurally wrong, or that our body is somehow being threatened. And in certain instances of trauma or disease, that is most certainly the case. But the perception of pain can be deceiving, and it is influenced by many factors other than pathology or trauma.

Some factors that influence an individual’s pain perception include:

• Family attitudes about pain
• Cultural and social influences
• Emotional factors
• Past experience with pain
• Misconceptions about how the body works
• Lifestyle behaviors
• Fear of pain

When you experience non-specific chronic back pain, or non-specific pain of any nature, for that matter, there may be a number of underlying factors at play that influence the sensation and intensity of pain.

In order to get to the bottom of your pain, it is important to understand the mechanisms of the nervous system that contribute to pain perception. Your central and peripheral nervous systems interact to send endless messages back and forth about the state of your body. When nerves in your periphery encounter a stimulus, a message travels to your brain, and the brain decides how to interpret it. Essentially, your brain forms an opinion about the stimulus, drawing information from a variety of sources, including those listed above. If your brain perceives a threat, it may respond by producing a pain response.

Pain influences behavior, and behavior in turn influences the perception of pain. If you compensate for pain by changing the way you move and limiting your activities, you are in fact reinforcing the idea that something is wrong. In effect, you are substantiating your brain’s interpretation of a particular stimulus as a threat, and reinforcing the pain response.

Cognitive functional therapy (CFT) considers not only movement mechanics, posture and exercise. It is a person-centered approach that takes into account other cognitive factors. CFT is geared to correcting faulty posture and deficient movement patterns while at the same time discouraging pain behaviors, and retraining the way the brain perceives peripheral stimuli. While still in its developmental stages, clinical trials have yielded positive outcomes, and CFT holds promise for sufferers of chronic non-specific LBP.