Cognitive Functional Therapy Offers Long-Lasting Back Pain Relief

Credit: Adobe Stock/Jo Panuwat D

If you’re living with chronic low back pain, you’re not alone — and there’s some hopeful news on the horizon. A new study published in The Lancet Rheumatology has found that a treatment approach called cognitive functional therapy (CFT) can help people with long-term back pain improve their mobility and reduce pain — not just for a few months, but for years.

A team of investigators followed participants for three years and found that those who received CFT had better outcomes than those who received usual care. Even better? The benefits lasted long after treatment ended.

What Is Cognitive Functional Therapy (CFT)?

CFT is a personalized treatment that goes beyond managing symptoms. It focuses on helping people understand what’s contributing to their pain — whether it’s physical, mental or emotional — and gives them practical tools to move better, manage fear and build confidence. It’s not just about stretching or medication. It’s about understanding how your body and mind work together and learning how to take control.

The Study at a Glance

Investigators from Macquarie University in Australia, led by Mark Hancock Ph.D., professor at the Spinal Pain Research Center, Department of Health Sciences, wanted to understand how effective CFT really is in the long term. They studied 492 people who had experienced chronic low back pain for more than three months and who struggled with daily activities due to their pain.

“Although many people recover well from a single episode of back pain, for most people low back pain is a long-term health condition marked by unpredictable recurrences or pain flare-ups,” wrote Hancock. “Low back pain is currently the leading cause of years lived with disability globally, and the number of people living with chronic low back pain is projected to increase in the coming decades.”

In RESTORE, a phase 3 clinical trial, participants were split into three groups:

1. Usual care (such as advice, medication or general physical therapy)
2. CFT only
3. CFT with biofeedback (a special tool that uses sensors to help track movement)

Each person in the CFT groups had up to 7 treatment sessions over 12 weeks, plus a booster session around 6 months later.

After three years, investigators checked in with the participants to see how they were doing.

What They Found

The results were encouraging:

• People who had CFT (with or without biofeedback) had less pain and fewer limitations in their daily activities than those who received usual care.
• The improvements in movement and quality of life were still going strong three years later.
• Adding biofeedback didn’t significantly improve results compared with CFT alone — meaning the core therapy was already very effective.

This study suggests that a more personalized, whole-person approach like CFT could make a real difference — not just today, but for years to come.

What makes CFT different is its focus on the following:

• Understanding your pain and what triggers it
• Building confidence in your body
• Moving in ways that feel safe and strong
• Learning self-management strategies that stick

And importantly, people with chronic pain were involved in designing the study — so the treatment was made with real-life experience in mind.

“These long-term effects are novel and provide the opportunity to markedly reduce the effect of chronic back pain if the intervention can be widely implemented,” investigators concluded. “Implementation requires scaling up of clinician training to increase accessibility, and replication studies in diverse health-care systems.”