The Effect of Six Weeks of Functional Cognitive Training on Cognitive Factors among the People with Non-Specific Chronic Neck Pain; A Clinical Trial Study

Document Type : Original Articles


1 PhD Candidate, Department of Biomechanics and Sport Injuries, School of Education and Sport Sciences, Kharazmi University, Tehran, Iran

2 Assistant Professor, Department of Biomechanics and Sport Injuries, School of Education and Sport Sciences, Kharazmi University, Tehran, Iran

3 Associate Professor, Department of Biomechanics and Sport Injuries, School of Education and Sport Sciences, Kharazmi University, Tehran, Iran



Introduction: Neck pain is a common problem in human societies. The purpose of this study was to investigate the effect of six weeks of functional cognitive training on the cognitive factors of people with non-specific chronic neck pain.Materials and Methods: In this clinical trial study, 24 patients with chronic neck pain were randomly divided into two groups of cognitive functional exercise and control. Cognitive factors were assessed before and immediately after six weeks of cognitive training using pain self-efficacy questionnaire, pain catastrophizing scale, fear-avoidance believes inventory, and depression, anxiety, and stress-21 questionnaire. Data were analyzed using repeated measures ANOVA and paired t tests.Results: Comparison of two groups after treatment showed a significant difference in all cognitive variables; so that all factors were improved in the intervention group (P = 0.001). Paired t-test results also showed a significant difference in all variables in the intervention group, before and after the test (P = 0.001); but no significant difference was observed for the control group.Conclusion: The findings suggest that functional cognitive training can be used as a novel method to improve the cognitive factors among the people with chronic neck pain.


  1. Haldeman S, Carroll L, Cassidy JD. Findings from the bone and joint decade 2000 to 2010 task force on neck pain and its associated disorders. J Occup Environ Med 2010; 52(4): 424-7.
  2. McCracken LM. Social context and acceptance of chronic pain: The role of solicitous and punishing responses. Pain 2005; 113(1-2): 155-9.
  3. Jensen MP, Moore MR, Bockow TB, Ehde DM, Engel JM. Psychosocial factors and adjustment to chronic pain in persons with physical disabilities: A systematic review. Arch Phys Med Rehabil 2011; 92(1): 146-60.
  4. Klenerman L, Slade PD, Stanley IM, Pennie B, Reilly JP, Atchison LE, et al. The prediction of chronicity in patients with an acute attack of low back pain in a general practice setting. Spine (Phila Pa 1976) 1995; 20(4): 478-84.
  5. Picavet HS, Vlaeyen JW, Schouten JS. Pain catastrophizing and kinesiophobia: Predictors of chronic low back pain. Am J Epidemiol 2002; 156(11): 1028-34.
  6. Schutze R, Rees C, Preece M, Schutze M. Low mindfulness predicts pain catastrophizing in a fear-avoidance model of chronic pain. Pain 2010; 148(1): 120-7.
  7. Mantyselka P, Lupsakko T, Kautiainen H, Vanhala M. Neck-shoulder pain and depressive symptoms: a cohort study with a 7-year follow-up. Eur J Pain 2010; 14(2): 189-93.
  8. Jensen IB, Bergstrom G, Ljungquist T, Bodin L. A 3-year follow-up of a multidisciplinary rehabilitation programme for back and neck pain. Pain 2005; 115(3): 273-83.
  9. Lindell O, Johansson SE, Strender LE. Subacute and chronic, non-specific back and neck pain: Cognitive-behavioural rehabilitation versus primary care. A randomized controlled trial. BMC Musculoskelet Disord 2008; 9: 172.
  10. Jackson T, Wang Y, Wang Y, Fan H. Self-efficacy and chronic pain outcomes: A meta-analytic review. J Pain 2014; 15(8): 800-14.
  11. Asghari A, Nicholas MK. An investigation of pain self-efficacy beliefs in Iranian chronic pain patients: a preliminary validation of a translated English-language scale. Pain Med 2009; 10(4): 619-32.
  12. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995; 33(3): 335-43.
  13. Asghari A, Saed F, Dibajnia P. Psychometric properties of the Depression Anxiety Stress Scales-21 (DASS-21) in a non-clinical Iranian sample. International Journal of Psychology 2629; 2(2): 82-102.
  14. Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 1993; 52(2): 157-68.
  15. Ilnaz S, Hamid Taher ND, Hossein M, Reza BS. Cognitive and emotional factors effective on chronic low back pain in women: Explanation the role of fear-avoidance believes, pain catastrophizing and anxiety. J Res Behav Sci 2012; 9(5): 79. [In Persian].
  16. Sullivan MJL, Bishop SR, Pivik J. The Pain Catastrophizing Scale: Development and validation. Psychol Assess 1995; 7(4): 524-32.
  17. Rahmati N, Asghari Moghadam M A, SHAIRI M, Paknejad M, Rahmati Z, Ghassami M, et al. A study of the psychometric properties of the pain catastrophizing scale amongst iranian patients with chronic persistent pain. J Ilam Univ Med Sci 2017; 25(1): 63-79. [In Persian].
  18. O'Sullivan K, Dankaerts W, O'Sullivan L, O'Sullivan PB. Cognitive functional therapy for disabling nonspecific chronic low back pain: Multiple case-cohort study. Phys Ther 2015; 95(11): 1478-88.
  19. O'Sullivan PB, Caneiro JP, O'Keeffe M, Smith A, Dankaerts W, Fersum K, et al. Cognitive functional therapy: an integrated behavioral approach for the targeted management of disabling low back pain. Phys Ther 2018; 98(5): 408-23.
  20. Vlaeyen JW, Crombez G, Linton SJ. The fear-avoidance model of pain. Pain 2016; 157(8): 1588-9.
  21. O'Keeffe M, Purtill H, Kennedy N, O'Sullivan P, Dankaerts W, Tighe A, et al. Individualised cognitive functional therapy compared with a combined exercise and pain education class for patients with non-specific chronic low back pain: study protocol for a multicentre randomised controlled trial. BMJ Open 2015; 5(6): e007156.
  22. Caneiro JP, Smith A, Rabey M, Moseley GL, O'Sullivan P. Process of change in pain-related fear: clinical insights from a single case report of persistent back pain managed with cognitive functional therapy. J Orthop Sports Phys Ther 2017; 47(9): 637-51.
  23. O'Sullivan P. Diagnosis and classification of chronic low back pain disorders: maladaptive movement and motor control impairments as underlying mechanism. Man Ther 2005; 10(4): 242-55.
  24. Vlaeyen JW, de JJ, Geilen M, Heuts PH, van Breukelen G. Graded exposure in vivo in the treatment of pain-related fear: A replicated single-case experimental design in four patients with chronic low back pain. Behav Res Ther 2001; 39(2): 151-66.
Volume 14, Issue 6 - Serial Number 6
February 2019
Pages 318-324
  • Receive Date: 24 October 2019
  • Revise Date: 01 June 2022
  • Accept Date: 22 May 2022
  • First Publish Date: 22 May 2022