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Cognitive Functional Therapy for Persistent Pain Problems

Not all pain means there is structural damage.
Do any of the following apply to you?


  • You have had MRI scans with findings (MRI findings are often normal, and are present even for those without pain).
  • You have had MRI scans without findings.
  • If you’ve been told you have ‘weakness’, instability’, ‘damage’, ‘disc bulge’, ‘bone on bone’... regarding back pain or other persistent pain problems elsewhere in the body.
  • You have no history of physical trauma or accident.
  • Your initial injury was a long time ago but you’ve had ongoing or recurring symptoms since.
  • Conservative treatment like physio therapy, or other intervention such as surgery and injections haven’t helped.

Pain is generated in different ways, so it is useful to understand why you have pain in order to deal with it effectively.

Pain Types Image

What is pain?

There is no ‘pain centre’ in the body. All pain is experienced by our nervous system.

If you cut your finger, it’s your nervous system that receives and interprets information from the site of the cut, which then chooses whether or not to generate pain as a protective mechanism. This is slightly different to the damaged skin ‘feeling’ pain.

Have you ever cut or bruised yourself without realising because you didn’t feel it at the time? Have you heard of phantom limb pain? Our bodies and nervous system can do some pretty kooky stuff!

So pain is an experience generated by the nervous system when it receives information (from internal AND-OR external stimuli) and interprets the need to protect us in some way. Creating pain means we’re motivated to be careful so it can heal: that’s a pretty useful system.

It’s less useful when when this ‘protect’ mechanism goes awry and starts causing more problems than it helps.

If there’s no injury or trauma, or any obvious or logical reason for ongoing pain that isn’t ‘healing’, it may be time to rethink what’s going on and how it’s being dealt with.

What Is Pain Cft

Our pain ‘systems’ are created and influenced by every other system in the body, including things like our beliefs and behaviour, previous experience and current stressors.

The nervous system is constantly monitoring, adapting, protecting and searching for threat – all essential for survival, which is exactly what it’s supposed to do – and this process is different from person to person.

Pain systems are also highly changeable (neuro-plasticity) and with evidence emerging from research over the last 10 years or so, we are now understanding how much of an impact we can have on pain systems because we understand better the different ways pain comes about.

This is highly specific to each individual but the principles remain the same so we can come up with clear strategies for changing pain, according to the person and their painful problem.

New ways to address and overcome chronic pain

Recent studies have shown us that:

  • Pain killers are not helpful for chronic pain problems so a different strategy is needed.
  • Movement is necessary to overcome chronic pain, if you are scared of moving because of pain.
  • Practical safe strategies can be a great catalyst for changing the pain response.
  • Stress can play a big role in the pain response; whether pain is causing stress, or if you have external stressors for example in work, relationships or home life, these can all play a significant role by affecting our biology – stress hormones cortisol and adrenalin are far reaching and have been shown to impact pain.

Tame the Beast – It's time to rethink persistent pain (5 minute film).

“Pain scientists are starting to think differently about persistent (chronic) pain and its causes, and they're making exciting discoveries - like how you think about your pain can change the way it feels.

Here Professor Lorimer Moseley explains how pain works and explains new approaches to help reduce your pain.



This is good news, even for those who have suffered with longterm pain problems.

Getting the right kind of help can make all the difference if you’ve been struggling with pain for a long time.

This videos shows other useful ways of understanding pain and can help you to start thinking about your pain - and what you can do about it - differently.


What is Cognitive Functional Therapy (CFT)?

CFT is an effective patient-centred approach for addressing and overcoming persistent pain problems.

It provides a practical framework for formulating treatment that is entirely specific to the person and takes advantage of the plasticity (highly changeable nature) of the nervous system and biology involved in the pain response.

This approach covers a broad evidence base, the result is dynamic and collaborative treatment that works on retraining your pain systems to be less protective and as a result, change your pain response.

In involves addressing the nervous system’s many influencing factors: cognitive, emotional, social aspects, plus physical, lifestyle, motor/movement factors, along with behavioural and physiological input, co-morbidities and sensory hypersensitivity.

This broad spectrum approach reflects the complexity of some pain problems, and how other interventions fail to address these aspects (such as ‘normal’ rehab or other conservative approaches, or surgery and injections) and therefore may not get the desired results.

Thankfully CFT is comprehensive and practical, and the evidence base as a clinical treatment for chronic pain is growing.

Research into CFT and pain

The Body in Mind Research Group is based at The Sansom Institute for Health Research at the University of South Australia in Adelaide and Neuroscience Research Australia in Sydney.

It has active collaborations with editors scattered around the world and is seeking a better understanding of the interaction between the body, brain and mind in chronic and complex pain disorders.

You can read about published research behind the Cognitive Functional Therapy approach to treating chronic pain, and associated topics at BodyInMind.org.

Or click on the links below to read specific research articles:

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