Functional Therapy to study Process of Change in Pain-Related Fear: A Single Case Report

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Functional Therapy to study Process of Change in Pain-Related Fear: A Single Case Report

Management of persistent low back pain (PLBP) related to high pain-related fear is complex. Caneiro JP et al. conducted this case report to bring insights into the process of change in a person suffering from PLBP and high bending-related fear, who were managed with an individualized behavioural approach of cognitive functional therapy.

In this study, a retired manual worker with PLBP was enrolled. The patient claimed that his spine was regenerating and the only way to control pain is to avoid bending. At baseline, a high -risk profile of the Orebro Musculoskeletal Pain Questionnaire (score, 61/100) and high levels of pain-associated fear on the Tampa Scale of Kinesiophobia (score, 47/68) were determined. The various beliefs and behaviours were unhelpful, and this leads to a vicious cycle of fear and disengagement from valued life activities. The thoughts and responses of the patient were challenged using guided behavioural experiments, which indicates that the behaviour of the patient was modifiable and the pain controllable. Cognitive functional therapy management was tailored to target critical drivers of PLBP and delivered over six sessions in a 3-month period using a multidimensional clinical-reasoning framework.

The results of the study showed that there were improvements observed in bending-related fear, pain expectancy, and pain experience. The substantial changes in pain-related fear (Tampa Scale of Kinesiophobia: 33/68; change, -14 points) and risk profile (Örebro Musculoskeletal Pain Questionnaire: 36/100; change, -25 points) were also improved over an 18-month clinical journey. Positive changes were reported in mindset, understanding of pain, perceived pain control, and behavioural responses to pain in clinical interviews conducted at 6 and 18 months.

It was concluded that this case report could be helpful for clinicians in providing an insight to use a multidimensional clinical-reasoning framework to identify and target the critical drivers of the disorder. The cognitive functional therapy can be used to address unhelpful psychological and behavioural responses to pain in a person associated with PLBP and high pain-related fear.


J Orthop Sports Phys Ther. 2017 Jul 13:1-38

Link to the source:

Original title of the article:

Process of Change in Pain-Related Fear: Clinical Insights From a Single-Case of Persistent Back Pain Managed With Cognitive Functional Therapy


Caneiro JP et al.

Therapeutic, Back pain, Low Back, Case report, Efficacy, Tampa Scale of Kinesiophobia, Örebro Musculoskeletal Pain Questionnaire
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