COMPIN (Feasibility study)
Research type
Research Study
Full title
COgnitive Muscular therapy versus psychologically informed Physiotherapy In non- specific chronic Neck pain: a feasibility study (COMPIN)
IRAS ID
339104
Contact name
Nathan Brookes
Contact email
Sponsor organisation
University of Salford
ISRCTN Number
ISRCTN14479543
Duration of Study in the UK
1 years, 2 months, 1 days
Research summary
Chronic neck pain (CNP) is a common long term condition resulting in pain, disability and reduced quality of life. It is the fourth leading musculoskeletal cause of disability in the UK, yet it receives less research attention compared to other common conditions like low back pain. Current management typically involves a combination of advice, pain relief, and physiotherapy. However, recent reviews suggest that while this approach may result in short-term improvements, long-term effects are limited, requiring more effective interventions.
Emerging research has highlighted increased levels of muscle tension and altered pain signalling mechanisms in CNP, leading to generalised pain sensitivity and altered pain tolerance. Emotional responses further contribute to pain experiences and affect participation in physical activity. Current mainstream physiotherapy approaches for CNP do not prioritise psychological aspects of the pain experience. However, early research suggests their significance, therefore these factors warrant further consideration.
Current physiotherapy mainly focuses on manual therapy (massage/ manipulation) and exercise (strength, stretches). This approach does not directly target muscle overactivity and psychological involvement in pain, possibly explaining limited success. Research has demonstrated that electromyography (EMG) biofeedback shows promise in reducing CNP. Therefore, interventions combining biofeedback and psychological elements may be important.
A novel approach, Cognitive Muscular Therapy (CMT), combines psychologically informed practices with muscle biofeedback training to reduce muscle overactivity and alter pain-related beliefs. Initial application on five CNP patients demonstrated substantial improvement in pain and function using the ‘Neck Pain Disability Index’ (NDI) with participants acknowledging newfound insights into their pain experiences.
Our proposed study aims to conduct a feasibility study comparing CMT with psychologically informed physiotherapy (education, pacing, exercise and self management) for CNP patients at risk of long-term disability.In summary, CNP management requires new approaches that address its complex nature. CMT shows promise but further rigorous evaluation is required through comprehensive clinical trials.
Summary of results
Lay summary of study results: Lay Summary of the COMPIN Feasibility Study People with long lasting neck pain often struggle with everyday activities, reduced quality of life and often worry about their symptoms. Although exercise and physiotherapy can help, research shows that current approaches do not work well for everyone. There is also no clear agreement on the best type of physiotherapy for people whose symptoms continue for many months.
This study tested whether it is possible to run a large clinical trial comparing two different physiotherapy treatments for people at high risk of ongoing neck pain:
• Cognitive Muscular Therapy (CMT) – a new treatment that teaches people how tension in their muscles and stress in their body can affect pain. The therapy uses hands on guidance, videos, and muscle activity feedback to help people relax unnecessary muscle tension and move with more confidence.
• Psychologically informed Physiotherapy (PiP) – an established physiotherapy approach that combines education about pain, relaxation, stretching, goal setting, pacing, and graded exercise. It is designed to address both the physical and emotional aspects of chronic pain.
What was the purpose of the study?
The study aimed to find out whether a bigger trial would be possible in the future. Before running a large full scale project, researchers needed to check:
• If enough people could be recruited
• If people found the treatments acceptable
• If people attended their physiotherapy sessions
• If most people stayed in the study long enough to provide follow up results
• Whether early results suggest potential benefits of CMT
Who took part?
Forty six adults with neck pain lasting more than three months took part. Everyone was considered to be “high risk” of ongoing pain using a screening tool called the STarT MSK Tool (a questionnaire that predicts who may need more support). People came from a wide range of ages, ethnic backgrounds, religions and occupations, making the study relevant to the wider UK population.
What did participants do?
Participants were randomly assigned (like flipping a coin) to either CMT or PiP. They attended 5-7 physiotherapy sessions over a number of weeks and completed questionnaires about pain, movement, disability and quality of life at the start, 14 weeks and 26 weeks.REC name
London - Riverside Research Ethics Committee
REC reference
24/LO/0291
Date of REC Opinion
9 May 2024
REC opinion
Further Information Favourable Opinion