Neuroscience & Medicine, 2011, 2, 71-77 71

doi:10.4236/nm.2011.22011 Published Online June 2011 (http://www.SciRP.org/journal/nm)

Treatment for Depression with Chronic Neck Pain

Completely Cured in 94.2% of Patients Following
Neck Muscle Treatment
Takayoshi Matsui1,2, Toshiro Fujimoto3*
1
Tokyo Neurological Center, Tokyo, Japan; 2Matsui Hospital, Kagawa, Japan; 3Fujimoto Hayasuzu Hospital, Miyazaki, Japan.
Email: ceo@fujimoto.or.jp

Received March 11th, 2011; revised April 14th, 2011; accepted April 23rd, 2011.

ABSTRACT
We report three patients with cervical neuromuscular syndrome (CNMS) who followed similar courses. Autonomic im-
balance may occur following neck muscle pain, and a wide variety of somatic symptoms including headache and ver-
tigo appear and a generalized poor condition may continue for long periods. If many such somatic symptoms persist for
months to years, symptoms of depression are exacerbated. The patients end up in psychiatric clinics, where they are
diagnosed with depression, but they do not respond to antidepressants. Thus, they continue to suffer for many years.
These patients eventually were completely cured with the resolution of neck pain by neck muscle treatment, using two
types of special low-frequency therapy equipment, far-infrared radiation and acupuncture. When treatment for the neck
muscles is initiated, symptoms of depression are quickly relieved, and diverse somatic symptoms disappear one after
another as neck muscle tension is gradually alleviated (the number of abnormal neck muscle checkpoints decreases).
Such a course suggests that neck muscle tension and chronic pain are closely related to depression. Neck muscle-re-
lated depression due to CNMS clearly differs from psychiatric conditions such as major and bipolar depression. In pa-
tients with neck muscle-related depression, symptoms of depression are not accompanied by ungrounded anxiety, a
sense of emptiness, apathy, or self-rejection. Neck muscle abnormalities leading to CNMS are caused by head injury,
whiplash injury, and a prolonged forward-bent-posture due to using a personal computer, playing computer games,
texting, and engaging in machine-paced work such as assembly-line operation.

Keywords: Cervical Neuromuscular Syndrome, Depression, Neck Muscle Pain, Neck Muscle Tension,
Autonomic Imbalance

1. Introduction dry eyes); abdominal symptoms (nausea, anorexia, sense

of abdominal fullness, swallowing difficulties, diarrhea,
Reports that chronic pain often causes depression and and abdominal pain); and mental symptoms (sickness on
emotional disorders are increasing [1-5]. Although the the day of or the before bad weather, depressed mood,
relationship of chronic pain to depression remains un- reduced -concentration, anxiety, lack of perseverance,
clear, it may be related to the multidimensional nature of easy fatigability, and feeling of chest compression) (Ta-
pain, which has biological, psychological, and biopsy- ble 1). Symptoms such as panic disorder, menopausal
chosocial parameters [6-9]. In particular, chronic pain disorders, chronic fatigue syndrome, and hyperhidrosis,
and tension in neck muscles induce a wide variety of which are not included in the Matsui Index, are also oc-
symptoms including chronic dystonia, headache, and casionally observed.
dizziness [10-13]. These symptoms include headache, neck Patients suffering from these diverse symptoms have
pain, and shoulder pain; dizziness and unsteadiness; nau- visited one hospital after another, but the causes remain
sea; insomnia; unsteady blood pressure; abnormal body unidentified, and they receive diagnoses of depression,
temperature control; perspiration abnormalities; palpita- autonomic disturbance, adjustment disorders, neuropathy,
tion; salivation abnormalities; mild fever; visual and ocular or hypochondriasis. These patients commonly exhibit
abnormalities (reduced or blurred vision, easy fatigability symptoms of depression and are frequently diagnosed
and eye pain, increased sensitivity to light, and watery or with depression by psychiatrists. However, their condi-

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72 Treatment for Depression with Chronic Neck Pain Completely Cured in 94.2% of Patients Following
Neck Muscle Treatment

Table 1. Matsui index.

Symptoms
Headache or heavy headedness
Neck pain or tension
Stiff shoulders
Frequently catching a cold
Light headedness or vertigo
Feeling unstable while walking or standing
Nausea, anorexia
Difficulty in falling asleep and intermittent awakening at night
Unstable blood pressure
Difficulty remaining in a warm place for a prolonged period (abnormal body temperature control)
Frequent sweating
Pounding heart at rest
Visual difficulty, blurry vision
Easily tried or painful eyes
Over-sensitivity to light or difficulty in keeping eyes open
Dry eyes or excessive tears
Saliva production is copious or absent
Mild fever (at 37˚C, occasionally exceeds 38˚C)
Frequent diarrhea (gastrointestinal symptoms, such as abdominal pain)
Habit of lying down at daytime
Severe fatigability
Loss of interest in all activities or motivation
Feeling unwell during bad weather or the day before
Depressive mood or feeling down
Loss of concentration or attention
Generalized anxiety
Irritation or frustration
Impatience, difficulty in working or studying for long hours
Hot flushes, cold or numb hands or legs
Pain, pressure, or numbness in the chest

tions characteristically do not improve despite antide- diagnosis of depression. These characteristics indicate a
pressant medication or psychological therapies such as close relationship between the neck muscles and depres-
counseling causing prolonged suffering. sion, which was completely resolved in more than 94%
Matsui studied such patients for about 30 years to of the patients following the treatment of neck muscle
identify an appropriate treatment. After numerous trials abnormalities without antidepressants. Matsui called this
and errors, he established a treatment for neck muscles in new disease cervical neuromuscular syndrome (CNMS).
2005, and showed that the wide variety of symptoms The objective of this study was to evaluate the close
mentioned above can be cured by this treatment. These relationship between depression and chronic pain by
patients exhibit the important characteristic of having presenting three cases selected from 130 patients who
experienced symptoms for a prolonged period before the had neck muscle abnormalities, exhibited diverse symp-
diagnosis of depression by psychiatrists. Abnormalities toms, and were diagnosed with depression by psychia-
of the neck muscles probably induce the above somatic trists but eventually were completely cured with the reso-
symptoms, and their persistence eventually leads to a lution of neck pain by neck muscle treatment.

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 Treatment for Depression with Chronic Neck Pain Completely Cured in 94.2% of Patients Following 73
Neck Muscle Treatment

2. Subjects and Methods nocobalamin (1,000 g/day) were used.

2.1. Subjects 2.3. Subjective Complaints
One-hundred thirty-eight patients were treated for CNMS Thirty symptoms frequently observed in CNMS as shown
between January 6, 2006, and August 4, 2008. They were in Table 1 were selected and checked during history
given the following primarily physical treatments tar- taking.
geted to the sites of objective abnormalities in two types
2.4. Objective Findings
of muscle.
Neck muscles were examined for muscle rigidity and
2.2. Treatments
tenderness at 34 checkpoints (Figure 1).
1. Two types of special low-frequency therapy equip-
3. Results
ment were used
1) Trimix Linus TM-5502 low-frequency SSP therapy Of the 138 patients treated at our hospital for neck mus-
equipment from Nihon Medix Co., Ltd., and cle disorders between January 6, 2006 and August 4,
2) Topra LCA-204 W.E.S low-frequency therapy 2008, 130 were cured, with a cure rate of 94.2%. Three
equipment from Celcom Medico, Inc. typical cases are described.
2. Far-infrared radiation
3.1. Case 1
Therapia 3300 infrared therapeutic device from Nihon
Medix Co., Ltd. A 40-year-old female began to have headaches in the
3. Acupuncture second half of her 20s. She had frequent headaches when
Nobel Pulse RP-4 electric acupuncture device from she was 35, and she also had hot flushes, a feeling of
Riken Iryo Denki, chest compression, and palpitations, which she felt were
4. Drug therapy due to the climacteric. This was followed by irritation
Fursultiamine (50 mg/day), thiamine disulfide (100 and impatience, and she became unwilling to do anything
m/day), pyridoxine hydrochloride (10 mg/day), and cya- and lost volition.

Figure 1. Muscle rigidity and tenderness were examined at the 34 checkpoints in the neck muscles.

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74 Treatment for Depression with Chronic Neck Pain Completely Cured in 94.2% of Patients Following
Neck Muscle Treatment

At the age of 38, she suddenly felt a stinging sensation lack of volition, unexplained anxiety, irritation, and im-
in her eyes and had an episode of mosaic defects of the patience disappeared.
visual field, which lasted for five minutes. Similar epi- Three weeks after admission, symptoms including a
sodes recurred many times, and defects of the visual field lack of concentration and impatience were resolved, re-
persisted for 30 minutes per episode. Although she con- sulting in the resolution of all mental symptoms. After
sulted an ophthalmology department, no abnormality was four weeks, symptoms including easy fatigability, blur-
found. She was referred to a neurology department and red vision and eyestrain, abnormal body temperature con-
underwent various examinations including MRI, CT, and trol (not being able to stay in a warm room), and abnor-
blood tests. She was diagnosed with migraine and tension mal perspiration disappeared.
headache and medicated. She thereafter began to feel General fatigue was resolved after five weeks. Vertigo
heaviness of the neck and head and often spent all day in and dizziness disappeared after six weeks, insomnia was
bed. She was dazzled by light and could not drive or go resolved after seven weeks, and cold feet disappeared
out without sunglasses even on cloudy or rainy days. after nine weeks. After 10 weeks, headache and weather-
Headaches further intensified despite medication. She dependent sickness were fully resolved. The intensifica-
began to stay recumbent whenever possible as she felt tion of symptoms before bad weather is a characteristic
dizzy in an upright position and as if the ground was of CNMS. Only neck and shoulder stiffness remained,
swaying when she walked. Vertigo sometimes persisted and, although they were also expected to be resolved by
even after she lay down. She consulted one hospital after continuation of the hospital stay, the patient was dis-
another and repeatedly underwent various examinations, charged after 10 weeks for family reasons.
but no abnormality was detected. While she complained About two months after admission, she began to wish
of many abnormalities, she was not diagnosed. Her fam- to be discharged, being very eager to resume her life, and
ily could not understand why she was sick. Because she appeared to be a totally different person compared with
appeared normal, she was thought to be lazy and malin- when she was admitted. Because autonomic activities
gering, and this suspicion grew in her family. She gradu- were normalized, she even began to appear much health-
ally lost the willingness to do anything and tended to ier than an average woman of her age. This is a common
avoid even talking to others. When she went shopping, feature of patients who have undergone this treatment,
she felt sick in crowded places, and she once fell asleep and many of them begin to look 10 or more years
in her car at a shopping center. She began to avoid going younger than they used to. The patient also stated that
out. Because she showed no improvement under the care she felt as mentally and physically healthy as if she had
of a neurologist, she was referred to a psychiatrist and been reborn. At discharge, the patient, whose gait had
was diagnosed with depression. been unstable, walked steadily and held cheerful conver-
She was medicated with an antidepressant and tran- sations, being relieved of the symptoms of depression.
quilizer and received counseling, but these treatments She said she had begun to think positively.
were ineffective. She became more depressed and devel- No recurrence of depression has been noted for three
oped vertigo, headache, and nausea. Because she could not years since discharge.
even stand up due to vertigo, she consulted an otorhi-
3.2. Case 2
nolaryngologist, whose diagnosis was Meniere’s disease.
She received an intravenous antivertigo drip and took Four years prior, a 55-years-old male had developed
more than 10 kinds of oral preparations daily with no headache and eye strain. He could not continue working
improvement. She frantically screamed and threw things into the evening due to neck pain, headache, and eye
at her children and became unable to perform housework. symptoms. Because symptoms of depression were also
Around this time, her husband heard of CNMS and took exacerbated, he consulted a psychosomatic clinic. The
her to the TNC, where she was admitted for treatment. diagnosis was depression, and sleeping pills and sero-
On admission, no particular abnormality was noted on tonin and norepinephrine reuptake inhibitors (SNRIs)
ECG, chest X-ray, blood chemistry tests, or urinalysis. were prescribed. However, the treatment was ineffective
Abnormality was observed at all 34 checkpoints in the for headache, and no improvement in the eye symptoms
neck muscles, and, on inquiry, 26 of the 30 symptoms on was noted. Although the doctor told him that headache
the checklist were positive. One week after admission, and neck pain would be alleviated with the resolution of
nausea, mild fever (a characteristic symptom of CNMS, depression, symptoms of depression alternately showed
the cause of which remains unknown), and intestinal mitigation and exacerbation over more than a year. The
symptoms such as diarrhea disappeared. After two weeks, sleeping pills and SNRIs had some effects on the symp-
most symptoms of depression including depressed mood, toms of depression, but no effect on the headache and

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 Treatment for Depression with Chronic Neck Pain Completely Cured in 94.2% of Patients Following 75
Neck Muscle Treatment

eye strain, which were his chief complaints. Patients with 3.3. Case 3
depression often experience an exacerbation of symp-
A 24-years-old female became totally unable to do
toms at fixed hours of the day such as the early morning,
housework due to neck pain, headache, nausea, vertigo,
but this patient felt well every morning, and headache
shoulder stiffness, and eye pain. She could not even leave
and eye pain gradually intensified as he worked, so he
her house. She consulted a hospital, was diagnosed with
questioned his diagnosis of depression. He obtained a
depression, and was administered an antidepressant.
medical certificate issued by his attending physician, and
One and a half years ago, she sustained a whiplash in-
was transferred to a less strenuous division of his com-
jury and was treated for six months, but the neck pain
pany. Despite the decrease in work-related stress, no im-
was exacerbated. As the symptoms intensified, she re-
provement in his condition was observed during the year
peatedly attempted suicide.
that followed. He, therefore, consulted a contract physi-
cian of the company and was advised to take a two- She heard about the newly described disease CNMS
month leave of absence, which he took two years ago, and consulted the Tokyo Neurological Center, where she
with no improvement in the condition. was diagnosed with CNMS and admitted.
Nine months ago, he was informed of a newly de- On admission, 21 of the 30 symptoms on the checklist
scribed disease called CNMS and consulted the TNC. were noted. Although 25 symptoms were noted at the
Abnormality was noted at all 34 checkpoints in the neck initial examination, four symptoms disappeared during
muscles. At that time, he was taking SSRI and SNRI outpatient care. Abnormalities were observed at all 34
prescribed by the psychosomatic clinic. While hospitali- checkpoints in the neck muscles.
zation was necessary, he could not be admitted immedi- One week after admission, loss of interest or motiva-
ately because of a long waiting list, so he received neck tion, depressive mood, generalized anxiety, and irritation
muscle treatment as an outpatient. He had been medi- or frustration had disappeared. The number of symptoms
cated with paroxetine hydrochloride at 20 mg/day and had decreased from 21 to 16 with the disappearance of
sertraline hydrochloride at 50 mg/day for depression, but most symptoms of depression.
paroxetine hydrochloride was gradually reduced until After two weeks, the number of symptoms had de-
complete withdrawn during outpatient management. creased to seven, with no symptom of depression re-
The patient was admitted to Matsui Hospital two maining. Symptoms including vertigo, dizziness, shoul-
months previous. On admission, abnormality was noted der stiffness, insomnia, general fatigue, and coldness of
at 22 checkpoints in the neck muscles. The number of the hands and feet also disappeared.
symptoms had been reduced from 22 to 14 as a result of After three weeks, symptoms became unaffected by
outpatient treatment, and the number of abnormal check- the weather.
points was decreased from 34 to 22. Because all symp- After five weeks, hyperhidrosis disappeared.
toms of depression had disappeared during outpatient After six weeks, headache disappeared.
treatment, the antidepressants were gradually reduced to After seven weeks, eye symptoms such as blurred vi-
complete discontinuation. sion, eyestrain, and eye pain disappeared.
Two weeks after admission, all eye symptoms includ- After eight weeks, neck pain had almost disappeared.
ing dazzling, dry eye, and blurred vision disappeared. The number of symptoms was 0 at eight weeks after
Dizziness also disappeared, and the number of symptoms admission, but neck muscle abnormality remained at 2
affirmed on inquiries had decreased to five. After three checkpoints. She was discharged early due to her work,
weeks, headache also disappeared, and the dose of the but her cure was nearly complete. No neck pain or de-
antidepressant sertraline hydrochloride was reduced from pression has occurred during the three and half years
50 to 25 mg. After four weeks, insomnia was resolved. since discharge.
After five weeks, neck pain disappeared, and all antide- 4. Discussion
pressants were withdrawn. After seven weeks, shoulder
stiffness and cold feeling in the hands and feet disap- These are the first case reports of the condition called
peared, and, as no symptom was noted on inquiries, in- cervical neuromuscular syndrome (CNMS) by Matsui.
definite complaints were judged to have been resolved. This syndrome involves chronic neck pain (neck muscle
Thus, all symptoms disappeared and all checkpoints in tension), psychiatric symptoms (depression, anxiety), and
the neck muscles became normal during an 8-week hos- autonomic imbalance, but the symptoms of depression
pitalization, and the patient was discharged in a favorable are resolved first by treatment for the neck muscles, gen-
condition. No recurrence has been noted for 18 months eralized somatic symptoms then disappear with decreases
after discharge. in neck muscle abnormalities, and both psychological

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76 Treatment for Depression with Chronic Neck Pain Completely Cured in 94.2% of Patients Following
Neck Muscle Treatment

and somatic symptoms of CNMS eventually disappear. chronic pain. The borderline between physical and psy-
This study indicates the importance of the neck muscles. chological variables in the depression-related items on
This seems natural as the neck is the interface between the Minnesota Multiphasic Personality Inventory, Beck
the head and trunk. CNMS presents such a diverseity of Depression Inventory, and Center for Epidemiology Stu-
symptoms that patients are unsure of which medical spe- dies Depression Index is unclear, and interactions be-
cialty they should consult. However, whichever specialty tween the mind and body were noted in somatic disorders
they consult, only medication to alleviate the symptoms [18,19]. The diagnostic criteria of depression include a
in the field of that department is available. Patients few physical disorders that may be induced by chronic
eventually end up at the psychiatric department and are pain. The possibility that depression and chronic pain
diagnosed with depression, but this condition is not cured may be interpreted by the cause-effect relationship has
by antidepressants. been suggested [18,19]. Are depression and chronic pain
Patients with CNMS show similar clinical courses. comorbidities?
They show an onset with pain of the neck muscles, fol- Depression caused by CNMS has specific characteris-
lowed by autonomic imbalance, and as a wide variety of tics. Depression due CNMS often results in suicide. Most
somatic symptoms including headache and vertigo ap- patients with CNMS admitted to our hospital stated that
pear, a poor overall condition continues for some time. In they had considered or attempted suicide. The likelihood
addition, if many symptoms persist for months to years, of suicide is considered to be greater in CNMS than in
the patients become depressed and suffer over a long depression. The 30 checklist items for the diagnosis of
period. CNMS were selected from symptoms frequently ob-
When treatment of the neck muscles is initiated, de- served in patients with this disorder. It is important to
pression is quickly alleviated, and the somatic symptoms note that these items do not include feeling sad or mean-
called indefinite complaints disappear one after another ingless.
with relief of the tension of the neck muscles (decrease in This is considered to be an important difference of
the number of abnormal checkpoints) [11]. These changes neck muscle-related depression due to CNMS compared
suggest a close relationship between chronic neck pain with major or bipolar depression. Patients with neck
and depression. Furthermore, the alleviation and cure of muscle-related depression do not complain of unground-
depression not responding to antidepressants by treat- ed sadness, emptiness, inexplicable meaninglessness, or
ment of the neck muscles suggest neck pain as a possible self-refusal, even when they have severe symptoms of
cause of depression. depression, cannot leave their homes for years, and de-
Concerning the relationship between depression and scribe themselves as living corpses. Neck muscle-related
chronic pain of the neck muscles, Gatchel and Dersh depression may cause a prolonged depressed mood and
suggested two major problems (2002) [14]. The first is apathy and force the patients to shut themselves in their
the ambiguity of the definition of depression. In psychia- rooms, but not unexplained sadness.
try, the term depression is used to refer to mood disorders Symptoms of neck muscle-related depression are 1)
[15,16], and depression is defined as specific depressive loss of interest or motivation in all activities; 2) depres-
disorders [17] (as discrete psychiatric disorders by the sive mood and feeling down; 3) anxiety for no reason; 4)
DSM-III). Also, according to the DSM-IV-TR, which is loss of concentration or attention; 5) irritation or frustra-
currently used, depression does not include symptoms tion; and 6) impatience and difficulty in working or stud-
due to general physical disorders. Only when there is ying for many hours. CNMS caused by neck muscle ab-
evidence that the condition is a direct physiologic result normalities induces autonomic imbalance and brings
of a general physical disorder, can the diagnosis of about many indefinite complaints of physical disorders.
“mood disorders due to ‘the presence of general physical Because these symptoms are clearly related to neck mus-
disorders’” be made rather than depressive disorders, even cle abnormalities, they naturally disappear if the abnor-
when the condition is physiologically related to general malities are corrected.
physical disorders. On the other hand, outside psychiatry, We have succeeded in curing many depressed patients
depression is described as a general phenomenon of de- by employing this quite rational approach, i.e., normal-
pressive symptoms [17]. izing the neck muscles. The rapid propagation of per-
Secondly, there is a criteria overlap between depres- sonal computers, computer games, and mobile phones
sion and chronic pain [18,19]. Depression as a general may be a major factor in the recent rapid increase in a
medical term is related to symptomatic overlapping be- new-type of depression caused by neck muscle abnor-
tween chronic pain and depression. Due to criteria over- malities and increases in the number of suicides in Japan.
lap, symptoms of depression are described as reactions to Neck muscle abnormalities leading to cervical neuro-

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 Treatment for Depression with Chronic Neck Pain Completely Cured in 94.2% of Patients Following 77
Neck Muscle Treatment

muscular syndrome (CNMS) are caused by 1) injuries [10] T. Matsui, M. Matsui and K. Matsumura, “New Disease
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—Cervical Neuromuscular Syndrome (CNMS),” The
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