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

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An Erratum to this article was published on 08 May 2012

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.

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References

  1. Haldeman S, Carroll LJ, Cassidy JD, Schubert J, Nygren A (2008) The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and its Associated Disorders. Executive summary. Spine (Phila Pa 1976) 33(Suppl):S5–S7

    Article  Google Scholar 

  2. Guzman J, Hurwitz EL, Carroll LJ, Haldeman S, Côté P, Carragee EJ et al (2008) A new conceptual model of neck pain. The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and its Associated Disorders. Spine (Phila Pa 1976) 33(Suppl):S14–S23

    Article  Google Scholar 

  3. Hogg-Johnson S, van der Velde G, Carroll LJ, Holm LW, Cassidy JD, Guzman J et al (2008) The burden and determinants of neck pain in the general population. The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and its Associated Disorders. Spine (Phila Pa 1976) 33(Suppl):S39–S51

    Article  Google Scholar 

  4. Cotè P, van der Velde G, Cassidy D, Carroll LJ, Hogg-Johnson S, Holm LW et al (2008) The burden and determinants of neck pain in workers. The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and its Associated Disorders. Spine (Phila Pa 1976) 33(Suppl):S60–S74

    Article  Google Scholar 

  5. Binder AI (2007) Cervical spondylosis and neck pain. BMJ 334(7592):527–531

    Article  PubMed  Google Scholar 

  6. Croft P, Lewis M, Papageorgiou A, Thomas E, Jayson M, Macfarlane G et al (2001) Risk factors for neck pain: a longitudinal study in the general population. Pain 93(3):317–325

    Article  PubMed  CAS  Google Scholar 

  7. Linton S (2000) A review of psychological risk factors in back and neck pain. Spine (Phila Pa 1976) 25(9):1148–1156

    Article  CAS  Google Scholar 

  8. Ariens GA, van Mechelen W, Bongers PM, Bouter LM, van der Wal G (2001) Psychosocial risk factors for neck pain: a systematic review. Am J Ind Med 39(2):180–193

    Article  PubMed  CAS  Google Scholar 

  9. Foster N, Pincus T, Underwood M, Vogel S, Breen A, Harding G (2003) Understanding the process of care for musculoskeletal conditions—why a biomedical approach is inadequate. Rheumatology 42(3):401–404

    PubMed  CAS  Google Scholar 

  10. Hoving J, Gross A, Gasner D, Kay T, Kennedy C, Hondras M et al (2001) A critical appraisal of review articles on the effectiveness of conservative treatment for neck pain. Spine (Phila Pa 1976) 26(2):196–205

    Article  CAS  Google Scholar 

  11. Binder A (2006) Neck Pain. Clin Evid 15:1654–1675

    PubMed  Google Scholar 

  12. Hurwitz EL, Carragee EJ, van der Velde G, Carroll LJ, Nordin M, Guzman J et al (2008) Treatment of neck pain: noninvasive interventions. The Bone and Joint Decade 2000–2010 Task Force on Neck Pain and its Associated Disorders. Spine (Phila Pa 1976) 33(Suppl):S123–S152

    Article  Google Scholar 

  13. Victor L, Richeimer SM (2003) Psychosocial therapies for neck pain. Phys Med Rehabil Clin N Am 14(3):643–657

    Article  PubMed  Google Scholar 

  14. Klaber Moffett JA, Jackson DA, Richmond S, Hahn S, Coulton S, Farrin A et al (2005) Randomised trial of a brief physiotherapy intervention compared with usual physiotherapy for neck pain patients: outcomes and patients’ preference. BMJ 330(7482):75–78

    Article  PubMed  Google Scholar 

  15. Klaber Moffett J, McLean S (2006) The role of physiotherapy for non-specific back pain and neck pain. Rheumatology 45(6):371–378

    Article  Google Scholar 

  16. Schulz KF, Altman DG, Moher D (2010) CONSORT Group. CONSORT 2010 Statement: Updated guidelines for reporting parallel group randomised trials. J Clin Epidemiol 63(8):834-40

    Google Scholar 

  17. SAS/STAT User’s Guide (1990) Version 6, Fourth Edition, Vol 2, SAS Institute Inc., Cary, NC, USA

  18. Wheeler AH, Goolkasian P, Baird AC, Darden BV 2nd (1999) Development of the Neck Pain and Disability Scale: item analysis, face, and criterion-related validity. Spine (Phila Pa 1976) 24(13):1290–1294

    Article  CAS  Google Scholar 

  19. Monticone M, Baiardi P, Nido N, Righini C, Tomba A, Giovanazzi E (2008) Development of the Italian version of the Neck Pain and Disability Scale, NPDS-I. Spine (Phila Pa 1976) 33(13):E429–E434

    Article  Google Scholar 

  20. Huskinson EC (1974) Measurement of pain. Lancet 2(7889):1127–1131

    Article  Google Scholar 

  21. Ware JE, Sherbourne CD (1992) The MOS 36-Item Short-Form Health Survey (SF-36). Med Care 30(6):437–483

    Article  Google Scholar 

  22. Apolone G, Mosconi P (1998) The Italian SF-36 survey: translation, validation and norming. J Clin Epidemiol 51(11):1025–1036

    Article  PubMed  CAS  Google Scholar 

  23. Apolone G, Mosconi P, Ware J (2000) Questionario sullo stato di salute SF-36. Manuale d’uso e guida all’interpretazione dei risultati. [SF-36 quality of life questionnaire. User’s Manual and guide to the interpretation of results]. Guerini e Associati Editors, Milan (in Italian)

  24. Pool JJM, MT, Ostelo RWJG, Hoving JL, Bouter LM, de Vet HCV (2007) Minimal clinically important change of the neck disability index and the numerical rating scale for patients with neck pain. Spine (Phila Pa 1976) 32(26):3047–3051

  25. Spratt KF (2009) Patient-level minimal clinically important difference based on clinical judgment and minimally detectable measurement difference: a rationale for the SF-36 physical function scale in the SPORT intervertebral disc herniation cohort. Spine (Phila Pa 1976) 34(16):1722–1731

    Article  Google Scholar 

  26. Taylor SJ, Taylor AE, Foy MA, Fogg AJ (1999) Responsiveness of common outcome measures for patients with low back pain. Spine (Phila Pa 1976) 24(17):1805–1812

    Article  CAS  Google Scholar 

  27. Kay TM, Gross A, Goldsmith C, Santaguida PL, Hoving J, Bronfort G, Cervical Overview Group (2005) Exercises for mechanical neck disorders. Cochrane Database of Systematic Reviews (3):CD004250

  28. Karjalainen K, Malmivaara A, van Tulder M, Roine R, Jauhiainen M, Hurri H, et al. (2000) Multidisciplinary biopsychosocial rehabilitation for neck and shoulder pain among working age adults. Cochrane Database of Systematic Reviews (3):CD002194

  29. Pool J, Ostelo R, Knol D, Bouter L, de Vet H (2010) Are psychological factors prognostic indicators of outcome in patients with sub-acute neck pain? Man Ther 15(1):111–116

    Article  PubMed  Google Scholar 

  30. Vonk F, Verhagen AP, Twisk JW, Koke AJA, Luiten MWCT, Koes BW (2009) Effectiveness of a behavioural graded program versus conventional exercise for chronic neck pain patients. Eur J Pain 13:533–541

    Article  PubMed  Google Scholar 

  31. Pool JJM, Ostelo RWJG, Knol DK, Vlaeyen JWS, Bouter LM, de Vet HCW (2010) Is a behavioral graded activity program more effective than manual therapy in patients with subacute neck pain? Results of a randomized clinical trial. Spine (Phila Pa 1976) 35(10):1017–1024

    Google Scholar 

  32. Jensen IB, Bergstrom G, Ljungquist T, Bodin L, Nygren AL (2001) A randomized controlled component analysis of a behavioral medicine rehabilitation program for chronic spinal pain: are the effects dependent on gender? Pain 91(1–2):65–78

    Article  PubMed  CAS  Google Scholar 

  33. Jensen IB, Bergstrom G, Ljungquist T, Bodin L (2005) A 3-year follow-up of a multidisciplinary rehabilitation programme for back and neck pain. Pain 115(3):273–283

    Article  PubMed  Google Scholar 

  34. Jensen I, Nygren A, Gamberale F, Goldie I, Westerholm P, Jonsson E (1995) The role of the psychologist in multidisciplinary treatments for chronic neck and shoulder pain: a controlled cost-effectiveness study. Scand J Rehabil Med 27(1):19–26

    PubMed  CAS  Google Scholar 

  35. Manca A, Dumville JC, Torgerson DJ, Klaber Moffett JA, Mooney MP, Jackson DA, Eaton S (2007) Randomized trial of two physiotherapy interventions for primary care back and neck pain patients: cost-effectiveness analysis. Rheumatology 46:1945–1501

    Google Scholar 

  36. Jensen IB, Busch H, Bodin L, Hagberg J, Nygren A, Bergstrom G (2009) Cost effectiveness of two rehabilitation programmes for neck and back pain patients: a seven year follow-up. Pain 142(3):202–208

    Article  PubMed  CAS  Google Scholar 

  37. Schiltenwolf M, Buchner M, Heindl B, von Reumont J, Muller A, Eich W (2006) Comparison of a biopsychosocial therapy (BT) with a conventional biomedical therapy (MT) of subacute low back pain in the first episode of sick leave: a randomized controlled trial. Eur Spine J 15(7):1083–1092

    Article  PubMed  Google Scholar 

  38. Norlund A, Ropponen A, Alexanderson K (2009) Multidisciplinary interventions: review of studies of return to work after rehabilitation for low back pain. J Rehabil Med 41(3):115–121

    Article  PubMed  Google Scholar 

  39. Johnson RE, Jones GT, Wiles NJ, Chaddock C, Potter RG, Roberts C et al (2007) Active exercise, education, and cognitive behavioural therapy for persistent disabling low back pain: a randomized controlled trial. Spine (Phila Pa 1976) 32(15):1578–1585

    Article  Google Scholar 

  40. Lamb SE, Hansen Z, Lall R, Castelnuovo E, Withers EJ, Nichols V et al (2010) Group cognitive behavioural treatment for low-back pain in primary care: a randomised controlled trial and cost-effectiveness analysis. Lancet 375(9718):916–923

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to thank Kevin Smart for his help in preparing the English version of this paper.

Conflict of interest

None.

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Authors and Affiliations

  1. Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone (Milan), Institute of Care and Research, Salvatore Maugeri Foundation, IRCCS, Milan, Italy

    Marco Monticone, Catia Montironi & Barbara Rocca

  2. Scientific Institute of Pavia, Institute of Care and Research, Salvatore Maugeri Foundation, IRCCS, Pavia, Italy

    Paola Baiardi

  3. School of Physiotherapy, Bologna University, Bologna, Italy

    Carla Vanti

  4. Chair of Physical and Rehabilitation Medicine, Tor Vergata University of Rome, Rome, Italy

    Calogero Foti

  5. Orthopaedic Spine Unit, Hospital of Legnano, Legnano, Italy

    Marco Teli

  6. Department of Orthopaedics, Ospedale Civile di Legnano, Via Papa Giovanni Paolo II, 20025, Legnano, Italy

    Marco Teli

  7. School of Physiotherapy, University of Milan, Milan, Italy

    Tiziana Nava

  8. Manual Therapy Sciences, Padua University, Padua, Italy

    Silvano Ferrari

  9. Consorzio Valutazioni Biologiche e Farmacologiche, Pavia University, Pavia, Italy

    Paola Baiardi

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  1. Marco Monticone
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Correspondence to Marco Teli.

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Monticone, M., Baiardi, P., Vanti, C. et al. Chronic neck pain and treatment of cognitive and behavioural factors: results of a randomised controlled clinical trial. Eur Spine J 21, 1558–1566 (2012). https://doi.org/10.1007/s00586-012-2287-y

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  • DOI: https://doi.org/10.1007/s00586-012-2287-y

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