Cognitive functional therapy (CFT)-based rehabilitation improves clinical outcomes in UK military personnel with persistent low back pain

Conway, Dean; Ladlow, Peter; Ferreira, Jerusa Pires; Mani-Babu, Sethu; Bennett, Alexander N.

doi:10.1136/jramc-2018-001136

Cited by 12 publications

(7 citation statements)

References 26 publications

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“…One recent RCT showed CFT approaches are more effective than combining manual therapy and exercise, although the latter was still recommended as a multimodal pain approach. Similar results have been reported in patients with “high-risk” chronic pain, that is, patients with failure of multiple other pain reduction modalities [ 13 ].…”

Section: Cognitive Functional Therapysupporting

confidence: 84%

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CBT and CFT for Chronic Pain

Hadley¹,

Novitch

2021

Curr Pain Headache Rep

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Purpose of Review Chronic pain is a widespread public and physical health crisis, as it is one of the most common reasons adults seek medical care and accounts for the largest medical reason for disability in the USA (Glombiewski et al., J Consult Clin Psychol. 86(6):533-545, 2018; Schemer et al., Eur J Pain. 23(3):526-538, 2019). Chronic pain is associated with decreased functional status, opioid dependence and substance abuse disorders, mental health crises, and overall lower perceived quality of life (Korff et al., J Pain. 17(10):1068-1080, 2016). For example, the leading cause of chronic pain and the leading cause of long-term disability is low back pain (LBP) (Bjorck-van Dijken et al. J Rehabil Med. 40:864–9, 2008). Evidence suggests that persistent low back pain (pLBP) is a multidimensional biopsychosocial problem with various contributing factors (Cherkin et al., JAMA. 315(12):1240-1249, 2016). Emotional distress, pain-related fear, and protective movement behaviors are all unhelpful lifestyle factors that previously were more likely to go unaddressed when assessing and treating patient discomfort (Pincus et al., Spine. 38:2118–23, 2013). Those that are not properly assisted with these psychosocial issues are often unlikely to benefit from treatment in the primary care setting and thus are referred to multidisciplinary pain rehabilitation physicians. This itself increases healthcare costs, and treatments can be invasive and have risks of their own. Therefore, less expensive and more accessible management strategies targeting these psychosocial issues should be started to facilitate improvement early. As a biopsychosocial disorder, chronic pain is influenced by a range of factors including lifestyle, mental health status, familial culture, and socioeconomic status. Physicians have moved toward multi-modal pain approaches in order to combat this public health dilemma, ranging from medications with several different mechanisms of action, lifestyle changes, procedural pain control, and psychological interventions (Fashler et al., Pain Res Manag. 2016:5960987, 2016). Part of the rehabilitation process now more and more commonly includes cognitive behavioral and cognitive functional therapy. Cognitive functional therapy (CFT) and cognitive behavioral therapy (CBT) are both multidimensional psychological approaches to combat the mental portion of difficult pain control. While these therapies are quite different in their approach, they lend to the idea that chronic pain can and should be targeted using coping mechanisms, helping patients understand the pathophysiological process of pain, and altering behavior. Recent Findings CFT differs from CBT functionally, as instead of improving managing/coping mechanisms of pain control from a solely mental approach, CFT directly points out maladaptive behaviors and actively challenges the patient to change them in a cognitively integrated, progressive overloading functional manner (Bjorck-van Dijken et al. J Rehabil Med. 40:8...

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Section: Cognitive Functional Therapysupporting

confidence: 84%

“…CFT has also led to greater reductions in disability compared to group exercise and education intervention in those with chronic low back pain [ 13 ]. Interestingly, the British Military published a study in 2015 on CFT, as the most common reason for presentation in their armed forces is low back pain.…”

Section: Cognitive Functional Therapymentioning

confidence: 99%

CBT and CFT for Chronic Pain

Hadley¹,

Novitch

2021

Curr Pain Headache Rep

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“…SF-36 has been shown to be sensitive to social factors such as financial stability, employment and educational status as well as disease-associated status in population-based surveys ( 15 ). In previous studies, SF-36 scores were also found to be relatively low in military personnel ( 15 , 25 ). Consistent with the literature, we found lower SF-36 scores in our patient group compared to a previous study that was also conducted on Turkish population by Demiral et al ( 15 ).…”

Section: Discussionmentioning

confidence: 71%

Chronic Pain and Pain Belief in Active Military Personnel: a Cross-sectional Study

Karasel¹,

Cebeci²,

Sönmez

2020

Med Arch

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Background: Chronic pain (CP) and mental disorders are common among active military personnel (AMP) due to their potential exposure to various physical and psychological stressors. Aim: The aim of this study was to evaluate pain perception and beliefs regarding their pain among AMP suffering from CP using self-reported measures, and to understand the development and persistence of pain in AMP. Methods: Sixty male AMP outpatients suffering CP were included. All participants completed the following forms and questionnaires: Oswestry Disability Index(ODI), Visual Analogue Scale(VAS), Neck Disability Index(NDI), Bournemouth Questionnaire for neck(BQN), International Physical Activity Questionnaire(IPAQ), Hospital Anxiety and Depression Index(HADS), 36-item Short Form Survey(SF-36), Automatic Thoughts Questionnaire(ATQ), and Pain Belief Questionnaire(PBQ). Results: The mean age of the participants was 22.85±3.50 years, the median duration and frequency of pain were 12 months and 14.5 days in a month, respectively. The median of ODI scores was 26; three of patients were evaluated as crippled while 8 patients had severe disability. The HADS and PBQ-psychological scores were high in the patient group. Positive correlations were found between pain frequency and the ODI, VAS, NDI and PBQ-psychological scores. Relationships were also shown between PBQ-psychological and the VAS and ATQ scores. Correlations between ODI scores and ATQ scores were also revealed. Conclusions: Our results suggest that, in addition to the organic basis of pain, there is strong evidence for significant contribution from the psychological characteristics and pain-related beliefs of the patients. Physicians may choose a multi-dimensional perspective in the diagnosis and treatment of pain, especially in patients suffering from CP.

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“…КФТ направлена на изменение представлений пациента о БНЧС, ее течении и прогнозе (когнитивная часть) и повышение функциональной активности пациента в течение дня (функциональная часть) [16,24,25]. Во многих случаях важно объяснить пациенту, что усиление боли представляет нормальную реакцию на увеличение активности, которая не вызовет прогрессирования заболевания, а будет способствовать тренировке мышц и в дальнейшем уменьшению боли.…”

Section: практическая роль когнитивно-поведенческой и когнитивно-функ...unclassified

“…При лечении пациентов с БНЧС с помощью КФТ выделяют 4 направления: понимание пациентом боли, ее контроль, изменение образа жизни, повышение функциональной активности во всех направлениях [16,24,25]. В задачи КФТ входит проведение регулярных лечебных упражнений, нормализация двигательной активности с избеганием чрезмерных физических и статических нагрузок, отказ от сидячего образа жизни и нормализация сна, который часто нарушен при хронической боли в спине.…”

Section: практическая роль когнитивно-поведенческой и когнитивно-функ...unclassified

Cognitive functional therapy and non-steroidal anti-inflammatory drugs in the treatment of low back pain

Zinovyeva

Golovacheva

2023

Medicinskij sovet

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A multidisciplinary approach including drug and non-drug methods is recommended for the treatment of chronic low back pain (CLBP). Kinesiotherapy, psychological methods, and nonsteroidal anti-inflammatory drugs (NSAIDs) have been shown to be highly effective for CLBP. All of the listed methods contribute to significant relief and relief of pain, increase the patient’s social and physical activity, and improve the emotional state. Psychological methods help patients cope with catastrophizing pain, increase daily activities, and reduce the likelihood of disease recurrence. Results from clinical studies and systematic reviews demonstrate the effectiveness of psychological techniques such as cognitive behavioral therapy (CBT) and mindfulness therapy (mindfulness) in the treatment of CLBP. Cognitive Functional Therapy (CFT) is a promising new psychological method that was created on the basis of CPT. Clinical studies have been conducted confirming the efficacy of CFT in CLBP. CFT is aimed at regular therapeutic exercises, normalization of motor activity with avoidance of excessive physical and static exertion, avoidance of sedentary lifestyle and normalization of sleep, which is often disturbed in chronic back pain. In practice, patients with CLBP often have low adherence to increased physical activity during the day, to therapeutic exercises. In most cases, this is due to the fact that in the first days of increased physical activity there is an increase in pain. Patients mistakenly fear further progression of pain and disease. Prescribing NSAIDs usually results in pain reduction as early as the first days of administration, so patients with chronic musculoskeletal pain have an increased desire to engage in physical activity and therapeutic exercises. The choice of a particular NSAID medication is made individually, taking into account the co-morbidities and the risk of possible side effects. We discuss the use of nimesulide in CLBP.

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Cognitive functional therapy (CFT)-based rehabilitation improves clinical outcomes in UK military personnel with persistent low back pain

Cited by 12 publications

References 26 publications

CBT and CFT for Chronic Pain

CBT and CFT for Chronic Pain

Chronic Pain and Pain Belief in Active Military Personnel: a Cross-sectional Study

Cognitive functional therapy and non-steroidal anti-inflammatory drugs in the treatment of low back pain

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