A comprehensive approach involving a psychiatrist in the management of patients with chronic non-specific neck and back pain who also have anxiety and depressive disorders

   In cases of chronic non-specific neck and low back pain (CNLBP), where emotional disorders are identified, the involvement of a psychiatrist in patient management is considered. However, the effectiveness of this approach in patients with CNLBP and a confirmed anxiety or depressive disorder (F41, F33, F32) remains insufficiently studied.

   Objective: To conduct a comparative evaluation of the efficacy of a comprehensive approach (involving a psychiatrist, an educational programme incorporating elements of cognitive behavioural therapy (CBT), and personalised therapeutic exercise) versus a standard approach in the treatment of chronic non-specific low back pain (CNLBP) in patients diagnosed with an anxiety or depressive disorder (F41, F33, F32) by a psychiatrist.

   Material and methods. The study included 55 patients with CNLBP and anxiety (F41) or depressive disorder (F33, F32), who were randomized into two groups. The first group (comprehensive therapy – CT) consisted of patients (n=27) who received a comprehensive (multimodal) approach, including the involvement of a psychiatrist in patient management, 6 sessions of an individualized educational programme incorporating elements of CBT delivered by a certified specialist in chronic pain and emotional disorders, 4–5 individual sessions of therapeutic exercise (TE) with the development of a personalized exercise regimen, and recommendations on workplace ergonomics. The standard therapy (ST) group comprised patients (n = 28) who were treated using a standard therapy protocol (optimisation of drug therapy, a one-off educational programme to improve physical activity, and standard kinesiotherapy). The study protocol involved 6 months of therapy and fol-low-up with efficacy assessments at three time points – 1, 3 and 6 months after the start of treatment. A numerical rating scale (NRS) was used to assess pain intensity; the Spielberger test, which assesses state (ST) and trait (TT) anxiety, and the Beck Depression Inventory were used to assess anxiety and depressive disorders. The SF-12 questionnaire was used to assess quality of life, taking into account the division of this questionnaire into summary scales for physical (PCS-12) and mental health (MCS-12). To determine the impact of neck pain (NP), the Neck Disability Index (NDI) was used; to assess the impact of low back pain (LBP) on daily activities, the Oswestry Low Back Pain Disability Questionnaire was used.

   Results. Against the background of treatment, a more significant decrease in pain intensity according to the NRS was noted in the CT group than in the ST group – respectively, for NP to 1.46 ± 0.75 and 2.92 ± 1.0 after 3 months (p < 0.001) and to 0.69 ± 0.72 and 3.0 ± 1.41 after 6 months (p < 0.001), for LBP 2.04 ± 0.86 and 3.29 ± 1.31 after 3 months (p < 0.001), and to 1.04 ± 0.91 and 3.29 ± 1.48 after 6 months (p < 0.001), a decrease in functional impairment according to the Oswestry questionnaire to 15.57 ± 3.55 and 27.62 ± 3.27 after 3 months (p < 0.001) and up to 10.22 ± 2.54 and 29.67 ± 4.24 after 6 months (p < 0.001), a decrease in functional impairment according to the NDI to 12.54 ± 4.36 and 23.38 ± 4.5 after 3 months (p < 0.001) and up to 8.08 ± 2.81 and 25.23 ± 4.95 after 6 months (p < 0.001), an improvement in the quality of life according to PCS to 46.04 ± 4.31 and 43.21 ± 4.04 after 3 months (p < 0.05) and up to 50.07 ± 3.27 and 43.57 ± 3.17 after 6 months (p < 0.001), an improvement in the quality of life according to MCS to 47.3 ± 4.31 and 44.57 ± 3.13 after 3 months (p < 0.05) and up to 50.56 ± 2.86 and 44.75 ± 2.63 after 6 months (p < 0.001). During therapy, no significant differences were found between the CT and ST groups according to the Beck Depression Inventory, ST and TT, in both groups an improvement in the indicators was observed over time, however, when comparing the survey indicators after 3 and 6 months, the CT group showed a statistically significant improvement according to the Beck Depression Inventory (p = 0.04), while in the ST group no further changes were noted (p = 0.14).

   Conclusion. A comprehensive multidisciplinary approach (involving a psychiatrist) to the treatment of patients with chronic non-specific low back pain (CNLBP) and mental health disorders (anxiety and depressive disorders) leads to a more significant reduction in pain and an improvement in functional activity. Prescribed drug therapy for mental disorders improved the improvement in pain, functional activity and quality of life in the long term.

1. GBD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990–2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023 May 22;5(6):e316-e329. doi: 10.1016/S2665-9913(23)00098-X

2. GBD 2021 Neck Pain Collaborators. Global, regional, and national burden of neck pain, 1990–2020, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2024 Mar;6(3):e142-e155. doi: 10.1016/S2665-9913(23)00321-1

3. Volel BA, Petelin DS, Rozhkov DO. Chronic back pain and mental disorders. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(2):17-24 (In Russ.). doi: 10.14412/2074-2711-2019-2S-17-24

4. Carlsson AC, Wändell P, Ösby U, et al. High prevalence of diagnosis of diabetes, depression, anxiety, hypertension, asthma and COPD in the total population of Stockholm, Sweden – a challenge for public health. BMC Public Health. 2013;13:670. doi: 10.1186/1471-2458-13-670

5. Maske UE, Buttery AK, Beesdo-Baum K, et al. Prevalence and correlates of DSM-IV-TR major depressive disorder, self-reported diagnosed depression and current depressive symptoms among adults in Germany. J Affect Disord. 2016;190:167-77. doi: 10.1016/j.jad.2015.10.006

6. Johansson R, Carlbring P, Heedman A, et al. Depression, anxiety and their comorbidity in the Swedish general population: point prevalence and the effect on health-related quality of life. Peer J. 2013;1:e98. doi: 10.7717/peerj.98

7. Aaron RV, Ravyts SG, Carnahan ND, et al. Prevalence of Depression and Anxiety Among Adults With Chronic Pain : A Systematic Review and Meta-Analysis. JAMA Netw Open. 2025;8(3):e250268. doi: 10.1001/jamanetworkopen.2025.0268

8. Romanov DV, Petelin DS, Volel BA. Depression in neurological practice. Medical Council. 2018;(1):38-45 (In Russ.). doi: 10.21518/2079-701X-2018-1-38-45

9. Petelin DS, Anpilogova EM, Tolokonin AO, et al. The role of stressful traumatic events, personality traits and psychiatric disorders in the formation of chronic pain syndromes. Neurology Bulletin. 2024;LVI(2):157-67 (In Russ.). doi: 10.17816/nb632149

10. Petelin DS, Sorokina OYu, Troshina DV, et al. Anxiety disorders in general medical practice – clinical picture, diagnosis, optimized approaches to therapy. Medical Council. 2023;17(3):110-8 (In Russ.). doi: 10.21518/ms2023-053

11. Bondesson E, Larrosa Pardo F, Stigmar K, et al. Comorbidity between pain and mental illness – Evidence of a bidirectional relation-ship. Eur J Pain. 2018;22(7):1304-11. doi: 10.1002/ejp.1218

12. Parfenov VA, Yakhno NN, Davydov OS, et al. Chronic nonspecific (musculoskeletal) low back pain. Guidelines of the Russian Society for the Study of Pain (RSSP). Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(2S):7-16 (In Russ.). doi: 10.14412/2074-2711-2019-2S-7-16

13. Parfenov VA, Yakhno NN, Kukushkin ML, et al. Non-specific neck pain (cervicalgia). Guidelines of the Russian Society for the Study of Pain (RSSP). Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2023;15(5):4-12 (In Russ). doi: 10.14412/2074-27112023-5-4-12

14. Depressive episode, Recurrent depressive disorder. Clinical recommendations. Public organization “Russian Society of Psychiatrists”. 2024. Available at: https://cr.minzdrav.gov.ru/preview-cr/301_3

15. Generalized anxiety disorder. Clinical recommendations. Public organization “Russian Society of Psychiatrists”. 2024. Available at: https://cr.minzdrav.gov.ru/preview-cr/457_3 (In Russ.).

16. Hawker GA, Mian S, Kendzerska T, et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011;63(11):S240-S252. doi: 10.1002/acr.20543

17. Vernon H. The Neck Disability Index: state-of-the-art, 1991–2008. J Manipulative Physiol Ther. 2008;31(7):491-502. doi: 10.1016/j.jmpt.2008.08.006

18. Smeets R, Köke A, Lin CW, et al. Measures of function in low back pain/disorders: Low Back Pain Rating Scale (LBPRS), Oswestry Disability Index (ODI), Progressive Isoinertial Lifting Evaluation (PILE), Quebec Back Pain Disability Scale (QBPDS), and Roland-Morris Disability Questionnaire (RDQ). Arthritis Care Res (Hoboken). 2011;63(11):S158-S173. doi: 10.1002/acr.20542

19. Spielberger CD. Test Anxiety Inventory: Preliminary professional manual. Menlo Park; 1980.

20. Beck AT, Steer RA, Brown G. Beck Depression Inventory – II [Database record]. APA PsycTests; 1996. doi: 10.1037/t00742-000

21. Ware J Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220-33. doi: 10.1097/00005650-199603000-00003

22. Parfenov VA, Alekseeva LI, Vakhnina NV, et al. Musculoskeletal back pain, issues of optimizing diagnosis and treatment. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2025;17(6):135-42 (In Russ.). doi: 10.14412/2074-2711-2025-6-135-142

23. Mukhametzyanova AKh, Parfenov VA. Errors and optimization of management of patients with chronic lumbalgia: Discussion based on the clinical observation. Medical Council. 2024;18(22):47-52 (In Russ.). doi: 10.21518/ms2024-472

24. Isaikin AI, Nasonova TI, Mukhametzyanova AKh. Emotional disorders and their therapy in chronic low back pain. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2022;14(5):90-5 (In Russ.). doi: 10.14412/2074-2711-2022-5-90-95

25. Rasmussen-Barr E, Halvorsen M, Bohman T, et al. Summarizing the effects of different exercise types in chronic neck pain – a systematic review and meta-analysis of systematic reviews. BMC Musculoskelet Disord. 2023;24(1):806. doi: 10.1186/s12891-023-06930-9

26. Grooten WJA, Boström C, Dedering A, et al. Summarizing the effects of different exercise types in chronic low back pain – a systematic review of systematic reviews. BMC Musculoskelet Disord. 2022;23(1):801. doi: 10.1186/s12891-022-05722-x

27. Calafiore D, Marotta N, Longo UG, et al. The efficacy of manual therapy and therapeutic exercise for reducing chronic non-specific neck pain : A systematic review and meta-analysis. J Back Musculoskelet Rehabil. 2025;38(3):407-19. doi: 10.1177/10538127241304110

28. Cho WS, Park CB, Kim BG. Effects of exercise therapy on pain and disability in patients with non-specific neck pain : A systematic review and meta-analysis. J Bodyw Mov Ther. 2023;36:213-20. doi: 10.1016/j.jbmt.2023.07.010

29. Frutiger M, Borotkanics R. Systematic Review and Meta-Analysis Suggest Strength Training and Workplace Modifications May Reduce Neck Pain in Office Workers. Pain Pract. 2021;21(1):100-31. doi: 10.1111/papr.12940

30. Tersa-Miralles C, Bravo C, Bellon F, et al. Effectiveness of workplace exercise interventions in the treatment of musculoskeletal disorders in office workers : a systematic review. BMJ Open. 2022;12(1):e054288. doi: 10.1136/bmjopen-2021-054288

31. Dandale C, Telang PA, Kasatwar P. The Effectiveness of Ergonomic Training and Therapeutic Exercise in Chronic Neck Pain in Accountants in the Healthcare System : A Review. Cureus. 2023;15(3):e35762. doi: 10.7759/cureus.35762

32. Shariat A, Cleland JA, Danaee M, et al. Effects of stretching exercise training and ergonomic modifications on musculoskeletal discomforts of office workers: a randomized controlled trial. J Phys Ther. 2018;22(2):144-53. doi: 10.1016/j.bjpt.2017.09.003

33. McDowell CP, Dishman RK, Gordon BR, et al. Physical Activity and Anxiety : A Systematic Review and Meta-analysis of Prospective Cohort Studies. Am J Prev Med. 2019;57(4):545-56. doi: 10.1016/j.amepre.2019.05.012

34. Pearce M, Garcia L, Abbas A, et al. Association Between Physical Activity and Risk of Depression : A Systematic Review and Meta-analysis. JAMA Psychiatry. 2022;79(6):550-9. doi: 10.1001/jamapsychiatry.2022.0609

35. Rizzo RR, Cashin AG, Wand BM, et al. Non-pharmacological and non-surgical treatments for low back pain in adults : an overview of Cochrane reviews. Cochrane Database Syst Rev. 2025;3(3):CD014691. doi: 10.1002/14651858.CD014691.pub2

36. Fernandez-Rodriguez R, Alvarez-Bueno C, Cavero-Redondo I, et al. Best Exercise Options for Reducing Pain and Disability in Adults With Chronic Low Back Pain: Pilates, Strength, Core-Based, and Mind-Body. A Network Meta-analysis. J Orthop Sports Phys Ther. 2022;52(8):505-21. doi: 10.2519/jospt.2022.10671

37. Sidiq M, Muzaffar T, Janakiraman B, et al. Effects of pain education on disability, pain, quality of life, and self-efficacy in chronic low back pain: A randomized controlled trial. PLoS One. 2024;19(5):e0294302. doi: 10.1371/journal.pone.0294302

38. Ploutarchou G, Savva C, Karagiannis C, et al. The effectiveness of cognitive behavioural therapy in chronic neck pain : A systematic review with meta-analysis. Cogn Behav Ther. 2023;52(5):523-63. doi: 10.1080/16506073.2023.2236296

39. Lin LH, Lin TY, Chang KV, et al. Pain neuroscience education for reducing pain and kinesiophobia in patients with chronic neck pain : A systematic review and meta-analysis of randomized controlled trials. Eur J Pain. 2024;28(2):231-43. doi: 10.1002/ejp.2182