An interview with Daniel and his experience with Cognitive Functional Therapy for his chronic, disabling low back pain.

Over the last 1 year in physiotherapy private practice, working with Daniel has been my most fulfilling experience. With a free reign on treatment options and more time allocated for each client (compared to working in the government hospital), I was able to pay more attention to what each client really wants, and deserves.

Daniel has been a ‘textbook’ patient suffering from chronic pain, unable to work after an injury. Mind you, he wasn’t even a manual worker! He holds a desk job, yet he was unable to work effectively due to pain. As a ‘textbook’ patient with chronic pain, he was suffering, worried about his future and fearful of hurting himself. Using a very detailed interview, I was able to extract useful information from him to assist me in the construction of a physiotherapy intervention plan.

The goal of physiotherapy is always to improve one’s quality of life and pain relief comes together. Often in chronic pain, due to the complex changes in the nervous system, we may not be able to reduce pain completely. Hence, what we do is, within the limits of the pain disorder, enable the client/patient to achieve the highest level of physical function so that he/she is able to regain his/her roles/responsibilities in life. As most chronic pain disorders are highly associated with many negative psychological states, mainly depression and anxiety, targeting the ‘higher up’ brain centre when we deal with chronic pain is extremely important and research shows that it is essential.

Daniel suffered severe back pain after being involved in a road traffic accident (his car was hit by someone else) and wasn’t able to get back to work after more than 3 months. He had a history of previous back injuries and surgeries but they were managed with medications and over the years, he gained weight, led a sedentary lifestyle, was busy and there were many things going on in his life. After that car accident, he underwent a procedure for his back but that didn’t really help significantly, hence he was finally referred to a physiotherapist for the very first time. This video was done 2 months after he started physiotherapy, and he is currently still seeing me but at longer intervals. He has lost weight, led a healthier lifestyle, started jogging and gym on a regular basis and has just gotten back to full-time work and is a new dad since the start of 2016! Although he is not completedly pain-free and he is still on medication, he is much more positive (sees the glass ‘half-full’ instead of ‘half-empty’), he no longer believes that his pain is due to irreversible structural damage to his spine, he is not fearful of moving, he has a pleasant outlook of life, wishes to help other chronic pain sufferers and most importantly, he has gotten back his life.

My area of interest in musculoskeletal physiotherapy has always been in chronic low back pain. To have the chance to work with someone so disabled by back pain yet motivated to get well, it was a chance that I cannot miss. I am eternally grateful to my alma mater, Curtin University and the faculty that I was under, which is really ‘game-changing’ in the realm of chronic pain management in physiotherapy. Especially Prof Peter O’Sullivan and Dr Tim Mitchell who greatly influenced me in my physiotherapy practice. Ever since graduating, I have always been incorporating Cognitive Functional Therapy (or CFT for short) within standard physiotherapy intervention. A research shows that CFT significantly improves chronic, non-specific low back pain, quality of life and patients’ satisfaction not only short term, but long term too! Being something very new, I believe that this ‘framework’ will be utilized in most chronic pain management in physiotherapy in the future.

So what is CFT?

Cognitive functional therapy (CFT) is a patient-centred approach to management that targets the beliefs, fears and associated behaviours (both movement and lifestyle) of each individual with back pain. It leads the person to be mindful that pain is not a reflection of damage – but rather a process where the person is trapped in a vicious cycle of pain and disability. This is fuelled by a nervous system that is stressed and sensitized due to negative beliefs, fear, lost hope, anxiety and avoidance, linked to mal-adaptive (provocative) movement and lifestyle behaviours. (Peter O’Sullivan, www.bodyinmind.org)

I hope CFT can be more widely used!

Thank you for reading!

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