Efficacy of two brief cognitive-behavioural rehabilitation programmes for chronic neck pain: results of a randomized controlled pilot study

BACKGROUND: Current models of pain behavior suggest that kinesiophobia prevents the reacquisition of normal function, promotes the development of maladaptive coping strategies, and contributes to the disability associated with chronic neck pain (NP). AIM: Comparing two brief cognitive-behavioral programs aimed at managing kinesiophobia to understand which one induces better short-term improvements in disability, fear of movement, catastrophizing, adaptive coping strategies, quality of life (QoL), and pain intensity of chronic NP. DESIGN: Pilot, randomized, controlled trial, 3-months follow-up. SETTING: Outpatients. POPULATION: Subjects with chronic NP. METHODS: The population was randomized into two groups: group A (N.=15) underwent four sessions of cognitive-behavioral therapy (CBT) based on the NeckPix© (1-week duration); group B (N.=15) received four sessions of CBT based on the Tampa Scale of Kinesiophobia (TSK) (1-week duration). Afterwards, both groups attended 10 sessions of multimodal exercises (5-week duration). Primary measure: Neck Disability Index (NDI). Secondary measures: NeckPix©, TSK, Pain Catastrophizing Scale, Chronic Pain Coping Inventory, EuroQol-Five Dimensions, and pain intensity Numerical Rating Scale. Statistics: Linear mixed model analyses for repeated measures for each outcome measure to evaluate changes over time and between group. RESULTS: A significant effect of time was found for all outcomes, while no outcomes showed group and/or interaction effects. No changes were found in terms of NDI at the end of CBT, while a significant improvement of about 13 points was found for both groups at the end of the motor training (P=0.001). Similarly, in terms of quality of life there was no change after the CBT program, and a significant change at the end of the motor training, with a partial loss at follow-up. From CBT sessions to follow-up both groups showed a progressive reduction in kinesiophobia, with each group achieving a bigger change in the specific scale used for the CBT program. CONCLUSIONS: Two brief cognitive-behavioral rehabilitation programs based on different methodologies of managing fear-avoidance beliefs induced similar short-term improvements in subjects with chronic NP. Clinically significant changes in terms of disability were found in both groups only at the end of a 5-week motor training, regardless of the cognitive-behavioral rehabilitation program previously administrated. CLINICAL REHABILITATION IMPACT: Treatment of chronic NP requires cognitive modifications closely linked to physical performances in order to achieve mental adjustments and guarantee cognitive-behavioral as well as motor lasting changes.