title: Chronic neck pain and treatment of cognitive and behavioural factors: results of a randomised controlled clinical trial.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  Disability, pain and quality of life improved at the end of treatment in both groups, without differences between them.
authors.affiliation: Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone (Milan), Institute of Care and Research, Salvatore Maugeri Foundation, IRCCS, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Monticone
authors.forename: Paola
authors.initials: P
authors.lastname: Baiardi
authors.forename: Carla
authors.initials: C
authors.lastname: Vanti
authors.forename: Silvano
authors.initials: S
authors.lastname: Ferrari
authors.forename: Tiziana
authors.initials: T
authors.lastname: Nava
authors.forename: Catia
authors.initials: C
authors.lastname: Montironi
authors.forename: Barbara
authors.initials: B
authors.lastname: Rocca
authors.forename: Calogero
authors.initials: C
authors.lastname: Foti
authors.forename: Marco
authors.initials: M
authors.lastname: Teli
mesh_terms: D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D004185:Disability Evaluation; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D011795:Surveys and Questionnaires; D016896:Treatment Outcome