Low Back Pain Cognitive Functional Therapy

This is a treatment service intended to help patients with chronic lumbar back pain without radiation, neurological features, red flags or pathology. Cognitive functional therapy is an evidence based development of physiotherapy with good evidence for efficacy in patients who have recurrent or persistent pain and have not responded to conservative management.

The service is run by a specialist physiotherapist trained in Cognitive Functional Therapy and will be by video consultation or where necessary, face to face in Exeter.

Each patient will have a telephone triage to assess their suitability and will be screened on each consultation to ensure no symptom progression or red flag concerns are present. The referral will be returned if the patient does not meet the criteria or there is insufficient information contained within the referral.

Please note this is an additional service to Spinal Interface. Please follow the Adult Low Back Pain guidelines for all lumbar spinal referrals.

Refer on eRS named to Low Back Cognitive Functional Therapy Service

Orthopaedics>Spine>Back Pain>Cognitive Functional Therapy Review Service-15N

Primary Care Inclusion Criteria

6 months or more history of non-specific chronic lumbar back pain with or without non-progressive unilateral leg pain requiring support with pain and improving function which

is stable, defined as unchanging over 3 months or more AND

is provoked and relieved by postures, movement and activities AND

has no red flags, neurological deficit or alternative cause examples as specified in the exclusion criteria

Please note imaging is not a prerequisite for referral.

Exclusion criteria:

All red flag and high complexity causes including

Cauda Equina Syndrome and Conus Medullaris Syndrome
Back pain with any motor/sensory/sphincter disturbance including foot drop
Back pain associated with physical trauma
Visceral causes including Endocarditis, PE, Aortic Aneurysm
Primary or secondary cancer of the spine including Myeloma
Late complication directly related to recent Spinal Surgery even if discharged from follow up
Suspected or confirmed discitis, osteomyelitis or spinal abscess
Malignancy
Active inflammatory and metabolic bone causes

Under 18

Nerve root compression confirmed on MRI

Already had current MRI discussed at MDT

Specific low back pain diagnoses including

Neurological deficits consistent with radiological findings
Spinal stenosis, Disc prolapse
Non-pathological vertebral fractures
Spondylolithesis grade 3 or 4
Severe scoliosis and spinal deformity
Active inflammatory and metabolic bone causes
Visceral causes
Shingles and Post Herpetic Neuralgia

Neurological deficits requiring but not yet proceeded to, or awaiting, imaging including those awaiting review with the Spinal Interface service

Previous spinal surgery and not discharged from follow up

Lower limb surgery not discharged from follow up or within the last 6 months

Cervical and Thoracic Causes including concomitant cervical or thoracic symptoms

Widespread constant non-specific pain disorder

Pain without a clear mechanical behaviour

Unstable or limiting cardiac or other internal medical condition

NB: These selection criteria are not strict absolutes. If in doubt as to the suitability of the patient presentation, please make the referral as all patients are telephone triaged by the delivering clinicians before acceptance.

Contributors:

Mr Neil Davey, Cognitive Functional Physiotherapist
Dr Rebecca Hopkins, GP
Mr Steve Iliffe, Extended Scope Spinal Physiotherapist, Cornwall Foundation Partnership NHS Trust
Mr Steve Pritchard, Extended Scope Spinal Physiotherapist, Derriford

Date 24 November 2023