Chronic neck pain and treatment of cognitive and behavioural factors: results of a randomised controlled clinical trial

Abstract

Purpose Although there is growing evidence in favour of the bio-psychosocial approach to the treatment of persistent neck pain, it is questioned whether treating psychological factors can improve patient perceptions of disability, pain and quality of life. This randomised, controlled study with 12 months' follow-up was conducted to evaluate the efficacy of adding cognitive-behavioural principles to exercises for chronic neck pain. Methods Eighty patients were randomly assigned to the usual neck exercises plus cognitive-behavioural treatment (PTcb group, 40 subjects) or to treatment based on neck exercises alone (PT group, 40 subjects). Before treatment (T1), at the end of treatment (T2) and 12 months later (T3), all of the patients completed a booklet including the Neck Pain and Disability Scale, a numerical rating scale, and the Short-Form Health Survey Questionnaire (SF-36). Results The present trial failed to demonstrate its primary end point: the pre-and post-treatment difference in total NPDS scores was not statistically different between groups. Disability improved similarly in both groups over time, remaining stable until T3 in the PTcb group and slightly increasing at the same time in the PT group. Pain trends were comparable, with both groups showing an improvement between T1 and T2, and a slight worsening between T2 and T3. There were significant increases in all of the SF-36 domains except for health in general, and vitality in both groups by the end of treatment. SF-36 showed a between-group difference only for the physical activity domain (10.4; 95 % CI 2.4-18.5). Conclusion Disability, pain and quality of life improved at the end of treatment in both groups, without differences between them.

Comparative Effectiveness of Conservative Interventions for Nonspecific Chronic Spinal Pain: Physical, Behavioral/Psychologically Informed, or Combined? A Systematic Review and Meta-Analysis

“…Studies were excluded if no reply was received from the study author. 21 studies included in this systematic review were deemed to have a low risk of bias (>6/12) when scored using the CBRG bias assessment tool, with four studies 19,74,78,95 scoring the highest (9/12). Three studies 35,90,107 were deemed to have a high risk of bias (<6/12).…”

“…20 Furthermore, two studies chose the Low Back Outcome Scale 35, 36 and another two utilised the Neck Pain and Disability Scale. 78,88 Meta-analysis 22 of the 24 studies were included in the meta-analysis of pain and disability. Therefore, two studies 35, 107 were excluded from the analysis.…”

Evidence-Based Physical Medicine and Rehabilitation Strategies for Patients with Cervical Radiculopathy Due to Disc Herniation

“…In line with this notion, a study showed that a type of cognitive behavioral approach, termed graded exposure in vivo treatment, aiming at restoration of function, activities of daily living, and return to work rather than reducing pain, was useful in reducing pain-related fear in patients with work-related upper extremity pain in general and not specifically in those with cervical radiculopathy (16). Additionally, two recent randomized controlled trials (Jadad scores: 4 and 5) provided some evidence of effectiveness of cognitive behavioral treatments combined with a physical therapy program consisting of mostly exercises in terms of long-term sickness absence and pain, disability, and quality of life in combined groups of neck pain patients with no exclusion criteria for radicular findings (17,18).…”

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review

“…Monticone et al [24] have conducted a randomized controlled trial exploring the efficacy of adding treatment of behavioural factors to a program of rehabilitation with physiotherapy for chronic non-specific neck pain. In this study published in the August issue, 80 patients were randomly assigned to either a rehabilitation program or to a cognitive behavioural therapy added to rehabilitation.…”