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Low Back Pain Cognitive Functional Therapy


This service is 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 spinal referrals requiring Spinal Interface assessment for Pain Clinic or Spinal Surgery consideration or direct Spinal Surgical opinion.

 

Primary Care Inclusion Criteria

6 months + history of non-specific chronic lumbar back pain (without radiculopathy) which is

stable, defined as unchanging over 3 months or more AND

Primarily localised between L1 and gluteal folds 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
  • 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

 

Specific low back pain diagnoses including

  • Neurological deficits consistent with radiological findings
  • Sciatica, Spinal stenosis, Disc prolapse/annular tears, Modic changes
  • Non-pathological vertebral fractures
  • Spondylolithesis
  • 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

Significant change in circumstance anticipated (other than surgery) eg new treatments, family event, house move

Difficulty understanding the proposed aim, or language used in outcome questionnaires

History of personality disorder

Diagnosed psychiatric conditions requiring treatment with medication or counselling

 

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 onto the pilot.




Contributors

 

Mr Neil Davey, Cognitive Functional Physiotherapist

Dr Rebecca Hopkins, RMS GP Orthopaedic Guidelines Lead

 

Date 22/02/22

Date of next review 22/02/2023