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Pain Management
Cognitive Behavioural Therapy (CBT)
A surgeon's perspective on CBT and psychological therapies for spinal pain — what they are, why the evidence supports them, and why they are delivered by trained therapists, not by me.
Cognitive behavioural therapy, or CBT, is one of the better-evidenced treatments for persistent back pain, and it sits comfortably within a modern, honest approach to spinal care. It is not about telling anyone their pain is imaginary; it is a practical, skills-based therapy that helps people manage pain, stay active and reduce its impact on their lives. As a spinal surgeon I am not a psychologist or CBT therapist — these therapies are delivered by trained professionals — but I value them, and I think it is important that patients understand where they fit. This page explains, from a surgeon's viewpoint, what CBT for pain is and why the evidence supports it.
For information only — not medical advice. The content on this page is patient education to help you understand a condition or treatment. It is not a substitute for personalised assessment by a qualified clinician. Always consult your doctor or specialist about your own symptoms, diagnosis, and treatment decisions.
What CBT for pain is
CBT is a structured, practical therapy that helps people recognise and change unhelpful patterns of thinking and behaviour around their pain. For back pain, that often means addressing fear of movement, breaking cycles of avoidance and inactivity, pacing activity sensibly, improving sleep, and building confidence to do more despite pain. Related approaches — such as acceptance and commitment therapy and mindfulness-based methods — share the same practical, active spirit. The aim is not to convince anyone their pain is not real, but to give them tools to reduce its grip and to live more fully alongside it.
Why a surgeon values it
It might seem surprising for a surgeon to talk about psychological therapy, but it reflects an honest view of what helps persistent pain. Surgery has a clear and important role for the right structural problems, but a great deal of chronic back pain is not fixed by an operation, and for that, active self-management supported by therapies like CBT is among the most effective things available. Recognising this lets me be honest with patients about when surgery is and is not the answer, and to point them towards treatments that genuinely help. It is part of treating the whole person rather than just the scan.
How it is delivered
CBT and related psychological therapies are delivered by trained therapists, psychologists and pain-management programmes — not by me. They may be offered one-to-one, in groups, as part of a combined physical-and-psychological ("multidisciplinary") pain programme, or increasingly through supported online formats. My role is to recognise when someone would benefit, to explain it positively so it does not feel dismissive, and to help them access the right service through their GP or a pain-management team. The therapy itself is provided and guided by those professionals over a course of sessions.
What the evidence shows
CBT for back pain is well supported by high-quality evidence. Cochrane reviews and network meta-analyses find that psychological therapies, particularly CBT, produce modest but real and durable improvements in pain and disability for chronic low back pain, especially when combined with physical treatment. Landmark trials such as the BeST trial showed that group CBT delivered meaningful, cost-effective benefit, and multidisciplinary programmes combining physical and psychological treatment outperform usual care for disabling back pain. This solid evidence base is why I regard CBT as a valuable, mainstream part of care.
What to expect
Where CBT or a combined pain-management programme is likely to help, I will explain why and help direct people to the appropriate service; the therapy itself is delivered by trained therapists and pain teams over a series of sessions. It is offered as an active, evidence-based way to reduce the impact of pain and regain function — a complement to, and sometimes an alternative to, physical treatments, chosen according to the individual.
Disclaimer. The information provided on this page is intended for educational purposes only and should not be considered personalised medical advice. Mr Madi is a spinal surgeon; CBT and psychological pain therapies are delivered by trained psychologists, therapists and pain-management services. Every patient is different, and treatment options and outcomes depend upon an individual's diagnosis, symptoms, general health and personal circumstances. Decisions regarding treatment should always be made following consultation with your treating spinal surgeon, GP, psychologist, pain specialist or healthcare professional.
Evidence & further reading
- —Ho EK, et al. Psychological interventions for chronic non-specific low back pain: systematic review and network meta-analysis. BMJ 2022. (PMID 35354560)
- —Henschke N, et al. Behavioural treatment for chronic low back pain. Cochrane Database Syst Rev 2010. (PMID 20614428)
- —Ostelo RWJG, et al. Behavioural treatment for chronic low back pain. Cochrane Database Syst Rev 2005. (PMID 11034658)
- —Lamb SE, et al. Group cognitive behavioural treatment for low back pain in primary care (BeST trial). Lancet 2010. (PMID 20189241)
- —Physiotherapist-delivered cognitive behavioural interventions for low back pain: systematic review. 2024. (PMID 38876697)
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Every patient is different. The information on this page is a starting point — Mr Madi will tailor any plan to your specific imaging, symptoms and goals.