Depression, Anxiety Major Factors in Neck Pain

From Reuters Health Information
News Author: Megan Rauscher
CME Author: Désirée Lie, MD, MSEd

February 13, 2009 — Psychosocial distress, specifically depression and anxiety, are closely linked to recurrent or persistent neck pain, clinicians from Germany report in the journal BMC Musculoskeletal Disorders posted online January 26.

"For successful long term results, it is essential to consider psychosocial factors and to include them into therapeutic strategies" for neck pain, Dr. Martin Scherer from the University of Gottingen noted in comments to Reuters Health.

The study involved 448 patients from a general practice setting in Germany with at least one episode of neck pain between March 2005 and April 2006. These patients completed a comprehensive questionnaire including the Neck Pain and Disability Scale and the Hospital Anxiety and Depression Scale (HADS).

Forty-four percent of the study subjects were 50 years or older and nearly 80% were female. About one third had basic education and a similar proportion was unemployed or retired. More than half of the subjects (56%) reported neck pain on the day they completed the questionnaire and 26% had constant neck pain during the past year.

Based on their HADS response, 20% of subjects were classified as having depressive mood, and 28% reported being anxious.

According to Dr. Scherer and colleagues, in both crude and adjusted regression analyses, depression and anxiety were highly significantly correlated with increasing levels of neck pain.

When levels of depression and anxiety were classified by quartiles of the Neck Pain and Disability Scale, subjects with depressive mood or anxiety were highly likely to be in the group with the highest levels of neck pain.

The results, the researchers say, suggest that the degree of neck pain is related to the degree of psychological distress. "To put it in other words," they write, "the higher the pain level in patients with cervical problems, the more attention should be paid to psychosocial distress as an additional burden."

Dr. Scherer and colleagues also note that their findings are consistent with a recent systematic review, which investigated determinants and risk factors for neck pain in the general population and found "consistent evidence only for psychological health factors and for other health problems like musculoskeletal complaints and poorer self-rated health."

"Findings of our study," Dr. Scherer told Reuters Health, "underline that neck pain therapies are more likely to be efficient if care for chronic patients is not only symptom-oriented but focuses on psychosocial factors that have been proved to be central for development and prognosis of neck pain."

BMC Musculoskelet Disord. Published online January 26, 2009.

Reuters Health Information 2009. © 2009 Reuters Ltd.

Clinical Context

Neck pain is highly prevalent, with two thirds of the adult population affected during their lifetime. However, only 10% of neck pain recurs or is persistent. Although many therapeutic approaches have been advocated, recommendations for management do not integrate all knowledge about psychosocial factors as prognostic factors to determine the outcomes and course of neck pain.

This is a cross-sectional survey of patients with neck pain seen in a general-practice setting to examine lifestyle and psychosocial factors associated with neck pain.