Neck Pain, Depression, and CBT

neck pain depression cbt

Could CBT break the vicious cycle of chronic neck pain and depression?

Neck Pain and depression are often interlinked with some studies showing a four-fold increase in the risk of depression in those with chronic pain. The connection between the two conditions is often extremely complex, involving the immune system, endocrine system, and neurotransmitters, as well as psychosocial factors and other problems that may go unrecognized and, therefore, unaddressed. Many patients feel that their doctor has simply given up on identifying the cause of their pain if they suggest that it has a psychological root but oftentimes this is the case and may provide the answer where countless medications, physical therapies, and even neck surgery have failed to resolve the chronic neck pain.

CBT for Neck Pain and Depression

Not all patients with neck pain and depression respond to cognitive behavioral therapy, but there have been numerous studies showing benefits for patients with chronic pain disorders. This type of treatment allows patients to break the cycle of negative thought patterns connected to their pain and depression, which may then help them pursue treatment for the pain or even reduce pain as their depression lifts and tension and inflammation subsides. CBT can also help patients communicate their needs to family members, friends, and employers more effectively so that they feel that their pain is legitimate and worthy of assistance and accommodation. CBT may also help patients achieve more restful sleep which can help reduce pain and depressive symptoms in itself. CBT can, therefore, be beneficial both for patients with neck pain caused by depression and for patients whose neck pain has resulted in depression.


Which came first - stress and depression or neck pain?

Latest Research on CBT for Chronic Pain

A paper presented at the 6th World Congress of the World Institute of Pain detailed the findings of a study of CBT for chronic pain management and confirms the benefits of the treatment. A cognitive behavioral therapy program remained beneficial even three years after the patients’ finished treatment according to Magnus Olason, MD, who presented the paper. His team did not treat patients with opioids, analgesics or other medications and instead helped patients to manage relapse control and pain without such drugs. Over a hundred patients took part in the study which gave them a six-week program of pain management for noncancerous, musculoskeletal pain; nearly half the patients had had pain for five years or more, with 40% suffering from lower back pain. The patients had been prescribed pain relievers, NSAIDs, antidepressants, and relaxants but were screened by Olason’s team to see if CBT might help them.

Long-lasting Positive Effects of CBT for Pain

Seventy-nine patients were assigned to receive either CBT or a non-CBT program with the patients randomly assigned (the others were given a pain management program). Non-CBT patients had physical rehabilitation and exercise as the primary therapies and all patients appeared to have statistically significant reductions in pain, as well as anxiety and depression at the end of treatment and after a year. The differences however, between the CBT group and the others was that at three years the former still had a meaningful improvement in symptoms whereas the non-CBT groups had reverted to baseline scores for pain and other measurements such as quality of life. It is thought that CBT may help effect positive changes in the brain where chronic pain has resulted in abnormal thoughts and associations. This has been found in research using MRIs to look at patients’ brain patterns before and after cognitive behavioral therapy. Increased gray matter in the prefrontal cortex after CBT appears to indicate better control of pain in patients, and pain perception is also changed due to alterations in pregenual cingulate and somatosensory cortices according to Magdalena Naylor, MD, PhD, professor of psychiatry and director of the Clinical Neuroscience Research Unit at the University of Vermont’s MindBody Medicine Clinic in Burlington.

Antidepressants for Neck Pain

Many patients with chronic nerve pain are familiar with the drug amitriptyline, an antidepressant that is also an analgesic. In most cases, those with neurological pain in the neck are prescribed a low dose of amitriptyline rather than the higher doses given to patients where the drug is being used as an antidepressant. If depression is suspected in a patient, whether as an isolated condition, a problem causing the neck pain, or as an effect of neck pain, it may be that a physician decides a higher dose of amitriptyline could be beneficial.

Treating Neck Pain and Depression

The key it seems to treating neck pain and depression is to treat neck pain and depression. By addressing both conditions the patient has a better chance of relieving both, especially in cases where it is unclear which condition came first and which may be contributing to the other. Some medications may be helpful for both conditions, such as nervines, anxiolytics, and antidepressants, whilst therapies designed to aid relaxation are also often beneficial for both neck pain and depression. Yoga, CBT, acupuncture, and even massage therapy could help a patient to relax, break the cycle of stress, anxiety, and pain, and increase motivation to achieve a healthy state for both body and mind. Even by reducing pain a little it may appear to be more manageable and allow a person to return to work, social activities and exercise, and active participation in family life, all of which can then further increase happiness and motivation to fully resolve neck pain and depression.


Olason, M., CBT and Chronic Pain, an Interdisciplinary Approach, 6th World Congress of the World Institute of Pain: Abstract 260. Presented February 5, 2012.

Alda M, Luciano JV, Andrés E, Serrano-Blanco A, Rodero B, Del Hoyo YL, Roca M, Moreno S, Magallón R, García-Campayo J., Effectiveness of cognitive behaviour therapy for the treatment of catastrophisation in patients with fibromyalgia: a randomised controlled trial. Arthritis Res Ther. 2011 Oct 23;13(5):R173.

Dunne RL, Kenardy J, Sterling M., A Randomized Controlled Trial of Cognitive-behavioral Therapy for the Treatment of PTSD in the Context of Chronic Whiplash. Clin J Pain. 2011 Dec 30.

Aggarwal VR, Lovell K, Peters S, Javidi H, Joughin A, Goldthorpe J., Psychosocial interventions for the management of chronic orofacial pain. Cochrane Database Syst Rev. 2011 Nov 9;11:CD008456.

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