Is there a relationship between psychological stress or anxiety and chronic nonspecific neck-arm pain in adults? A systematic review and meta-analysis

J Psychosom Res. 2016 Nov:90:70-81. doi: 10.1016/j.jpsychores.2016.09.006. Epub 2016 Sep 9.


Purpose: To systematically review and analyze the research evidence linking stress or anxiety to chronic nonspecific neck-arm pain (NSNAP) in adults.

Subjects and methods: Data were obtained from Pubmed, Scopus, PsycInfo, Web of Science, Physiotherapy Evidence Database (PEDro) and The Cochrane library database from their inception to July 2015. Two authors independently conducted the searches, extracted data, and completed methodological quality assessments. The methodological quality of the cohort and case-control studies was evaluated using the Newcastle-Ottawa scale, whilst the quality of the Randomized Controlled Trial (RCT) was evaluated using the PEDro scale.

Results: Twenty-eight studies involving 39,166 participants met the inclusion criteria. Four studies, including 5 pair-wise comparisons, were included in the meta-analysis: Three were cohort studies and 1 was a cross-sectional study. The meta-analysis outcome demonstrated a relationship between chronic NSNAP and psychological stress. The estimate odds ratio for all studies combined was 2.33 (95% CI, 1.04-5.18; p=0.039). A high heterogeneity of the findings appeared (Q=28.94, I2=86% p=0.00).

Conclusion: This study shows that there is a strong relationship between stress and chronic NSNAP. Despite this finding, we cannot support that stress is a risk factor for chronic NSNAP due to the low quality of the results according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). It was not possible to make a quantitative analysis comparing the relationship between anxiety and chronic NSNAP. However, according to the qualitative analysis there is a strong relationship between anxiety and chronic NSNAP.

Keywords: Anxiety; Chronic pain; NSNAP; Neck-arm; Psychological stress.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Anxiety / diagnosis
  • Anxiety / epidemiology
  • Anxiety / psychology*
  • Arm / pathology
  • Chronic Pain / diagnosis
  • Chronic Pain / epidemiology
  • Chronic Pain / psychology*
  • Cross-Sectional Studies
  • Humans
  • Neck Pain / diagnosis
  • Neck Pain / epidemiology
  • Neck Pain / psychology*
  • Shoulder Pain / diagnosis
  • Shoulder Pain / epidemiology
  • Shoulder Pain / psychology*
  • Stress, Psychological / diagnosis
  • Stress, Psychological / epidemiology
  • Stress, Psychological / psychology*