The effectiveness of cognitive behavioural therapy in chronic neck pain: A systematic review with meta-analysis

ABSTRACT

We evaluated the effects of Cognitive Behavioural Therapy (CBT) alone or with additional interventions on pain, disability, kinesiophobia, anxiety, stress, depression, quality of life, and catastrophizing of patients with chronic neck pain (CNP). Nineteen studies met the inclusion criteria, and fourteen studies were quantitatively analysed. Risk of bias was assessed using the PEDro scale and the certainty of evidence using the GRADE approach. Studies were pooled (where applicable) and subgroup analyses were performed for CNP, or whiplash associated disorders. Studies compared—directly or indirectly—CBT interventions to no treatment, conservative interventions such as exercise and/or physiotherapy, or multimodal interventions. We present effect estimates at 8-week, 12-week, 6-month, and 1-year follow-up. Low certainty evidence suggests a clinically significant pain reduction (short-term) favouring CBT with or without additional intervention compared to no intervention SMD = −0.73; 95%CI: −1.23 to −0.23). Very low and low certainty evidence suggest clinically significant improvements in kinesiophobia (very short-term SMD = −0.83; 95%CI: −1.28 to −0.39 and short-term SMD = −1.30, 95%CI: −1.60 to −0.99), depression SMD = −0.74, 95%CI: −1.35 to −0.14) and anxiety SMD = −0.76, 95%CI: −1.34 to −0.18) favouring a multimodal intervention with CBT (short-term) compared to other conservative interventions. Combining different types of CBT interventions resulted in potentially heterogeneous comparisons.

KEYWORDS:

• Chronic pain
• conginitive behavioural therapy
• chronic neck pain
• behavioural therapies

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

All data is available in the manuscript, the tables, and the supplementary material.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/16506073.2023.2236296.