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For millions of people searching for lasting pain relief, persistent back pain can feel confusing and relentless. But world-leading researcher and clinician Professor Peter O’Sullivan offers a hopeful, evidence-based pathway forward - one that challenges many old myths and empowers people to take back control.

Early in his career, Peter believed what many still do: that back pain always means damage and that the spine needs protecting. He taught people to brace, keep the back straight and avoid movement. But after sustaining his own chronic back pain, he realised that these protective strategies were actually worsening his symptoms.

“I really had to teach myself to unlearn something… I was subliminally doing it without even consciously knowing”

This personal turning point sparked decades of research now shaping modern understanding of back pain relief. One of the clearest findings? Pain usually does not equal damage. Peter explains that 95% of people don’t fit into the category of structural back pathology that can be identified.

Instead, pain is more strongly influenced by sensitivity in the body - shaped by movement habits, beliefs, sleep, stress, and broader lifestyle factors.

These insights form the foundation of Cognitive Functional Therapy (CFT), a person-centred approach tested in the landmark RESTORE trial (Kent et al., 2023). Peter summarises the three pillars of CFT as:

Making sense of pain,
Building confidence through movement, and
Addressing lifestyle factors, including sleep, stress, physical activity and nutrition

The Lifestyle Factors of CFT: A Missing Piece of Pain Relief

Peter emphasises that lifestyle factors profoundly shape pain sensitivity.

“We know that… the factors that drive pain are different for different people”

CFT looks at these influences individually, helping people identify and change what matters most for their pain.

Physical Activity

Movement is one of the strongest protectors against pain.

“Physical activity… is really important for your mental health, physical health, every aspect of your health. It is like brushing your teeth”

Sleep

Sleep disruption is one of the most powerful pain amplifiers. Peter gives a clear example:

“People going to bed at two o’clock in the morning and getting four to five hours’ sleep… that’s just a disaster for pain”

Stress & Coping

Stress can heighten pain sensitivity.

“Often when we're stressed, we do all the things that actually reinforce our stress… drink more, sleep less, be on our phone more”

CFT helps replace these patterns with healthy coping strategies such as relaxation and breathing techniques.

Nutrition & Gut Health

While still an emerging field, Peter highlights promising early evidence linking diet, metabolic health, and pain.

He explains:

“There is emerging research around the microbiome… your gut health… impacted by things like stress as well as ultra-processed foods”

A Hopeful Path Forward

The combined power of these pillars - understanding pain, restoring confident movement, and addressing lifestyle factors - creates meaningful, lasting pain relief. In the RESTORE trial, participants receiving CFT had less pain, less disability, lower fear, and more confidence than those receiving usual care, with effects lasting three years and counting (Hancock et al., 2025).

At Pain Coach, we’re committed to helping clinicians identify the lifestyle factors that are most likely to bring pain relief. Try it for free by clicking free trial below.

References:

Hancock, M., et al. (2025). Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): 3-year follow-up of a randomised, controlled trial. The Lancet Rheumatology, 7(11), e789–e798.

Kent, P., et al. (2023). Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): A randomised, controlled, three-arm, parallel group, phase 3, clinical trial. The Lancet, 401(10391), 1866–1877.

Rethinking Back Pain Relief: What Professor Peter O’Sullivan Wants Everyone With Back Pain to Know