Man on a mission

Peter O’Sullivan has developed a new way of tackling complex back pain disorders.  Sally Priestley caught up with him

A native of New Zealand, Professor Peter O’Sullivan now calls the city of Perth, perched on Australia’s west coast, his home.

Being down under hasn’t stopped him from gaining an international reputation.

The professor of musculoskeletal physiotherapy at Curtin University of Technology has developed a model for assessing and managing complex back pain disorders, ‘Classification based – cognitive functional therapy’ (CB-CFT).

The model, based on years of clinical work and research findings conducted by his group and others, integrates cognitive strategies and specific movement training.

His approach, he argues, is proving to be more successful in reducing long-term pain, disability and fear of movement among patients with persistent pain disorders than manual therapy and stabilising exercises.  

This year, UK physios flocked to a three-day course led by Professor O’Sullivan at the Royal Free Hospital, London. The feedback was, he says, ‘fantastic’.

‘Many people have reported that they feel liberated to move beyond their previous framework of treating symptoms to get to the basis of the problem.

They report feeling more hopeful and confident – and less fearful – in dealing with patients with disabling back pain disorders.

‘And more importantly – they have told me that many of their patients are finding new hope as well.’

The UK is one of 20 or so countries that Professor O’Sullivan has visited to spread the message about his CB-CFT approach.

He has also presented at more than 60 national and international conferences and published more than 100 papers in international, peer-reviewed journals.

The CB-CFT model is a multidimensional approach to pain in the low back and involves a number of ‘levels’.

At its first level it excludes ‘red flag’ pathology and considers any specific pathology. Other levels focus on the pain profile (pain mechanisms) and provocative physical behaviours, as well as lifestyle, psychological and social factors.

Professor O’Sullivan stresses that many of these domains are inter-related, and ‘the factors combine and act to feed a  vicious cycle of pain and  disability’.

He says the second aspect of the system is an integrated management approach – cognitive functional therapy – which challenges a person’s movement, lifestyle and cognitive behaviours by providing them with alternative strategies to move, think about their pain and their body, and go about their daily lives.

‘Conventional approaches to management of low-back pain have been largely unsuccessful. There is emerging evidence that this approach is more effective and cheaper – and the patients like it,’ says Professor O’Sullivan.

He points to the work of Dr Jonathan Hill at Keele University, featured in the June 2012 issue of Physiotherapy.

‘The STarT Back trial is great example of the benefits of a targeted approach to managing people with back pain based on the identification of psychosocial risk factors,’ he says.

Professor O’Sullivan describes his work as an ‘on-going journey’.

‘My hope is to develop an international consensus for the classification of back pain across different disciplines.

Multi-centre trials need to be conducted and in other populations to further test the validity of the approach – and no doubt it will continue to evolve.’

Asked how his approach will improve patients’ lives, he says: ‘There is so much fear about back pain – we don’t fear ankle sprains and continue limping for years after – why should it be so different for backs?

‘It’s often fed with negative information, irrelevant radiological imaging generating fear, and the reinforcing of maladaptive protective behaviours.

‘Liberating society of these beliefs would bring a great reduction in suffering to many, especially our most vulnerable.’ fl

Sally Priestley

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