The Effect of Cognitive Behavioral Therapy in Chronic Neck Pain: A Systematic Review with Meta Analysis

 Several conservative treatments have been used in Chronic Neck pain (CNP) management. Cognitive Behavioral Therapy (CBT) has been advocated to be effective in neck pain and disability, however, its effectiveness has not been investigated systematically.

 To conduct a systematic review evaluation the effeteness of CBT in adults with CNP.

 Five electronic databases were searched to identify Randomized Control trials (RCT) comparing CBT with or without other additional treatments in pain, disability and kinesiophobia CNP patients. Two reviewers independently screened the RCT’s for eligibility, evaluated the study quality using the PEDro scale and rated the certainty of evidence using GRADE approach.

 Very low certainty evidence suggests that CBT as a monotherapy produced better results in kinesiophobia at the very short- short- mid-term follow-up compared to other conservative treatments and indicated no significant differences between CBT alone as compared to wait-and-see in all outcome measures. Finally, very low certainty evidence showed that CBT as a domain of a multimodal conservative treatment produced better results in kinesiophobia and depression at very short- and short-term follow-up compared to conservative treatment without CBT.

CBT as a monotherapy or as part of a multimodal conservative approach is more effective than conservative treatments alone in decreasing kinesiophobia and depression up to mid-term and short-term follow-up, respectively.

CBT is equally effective to conservative management in pain and disability in CNP patients but may serve a significant role in decreasing kinesiophobia and depression at least in the initial stage of rehabilitation.