Improvements in clinical pain and experimental pain sensitivity after cognitive functional therapy in patients with severe persistent low back pain
Low back pain (LBP) is the leading cause of disability. Despite increasing resources being spent on managing this condition, a significant proportion does not fully recover within a year. Failure to recover often results in a trajectory of seeking pain specialist’s second opinions, surgical evaluations, and high use of opioid medication. Evidence suggests that persistent low back pain (pLBP) is a multidimensional biopsychosocial problem with various contributing factors, such as negative pain cognitions, pain-related fear and emotional distress, avoidant and protective movement behaviours, and unhelpful lifestyle factors such as activity avoidance and sleep problems. Current guidelines recommend that patients with pLBP who do not benefit from primary care treatment should be referred to multidisciplinary pain rehabilitation in secondary care settings. However, such treatments are often expensive, not easily accessible, and have small effects. Therefore, less expensive and more accessible management strategies targeting these multi-dimensional barriers to recovery may facilitate earlier improvements.