Non-specific chest pain in patients with normal coronary arteries is common and leads to excessive use of medical care and morbidity in patients. A number of common psychiatric disorders have been associated with non-specific chest pain, most commonly panic disorder and depression. The cause of this type of pain has been broadly investigated without any consent, however few clinical trials have evaluated treatment.
The aim of this paper is to identify and critically examine studies of psychological treatment for non-specific chest pain in patients with normal coronary anatomy.
Two databases, PubMed Ovid (1996 to week 3 of 2007) and PsychInfo Ovid (2000 to week 4 in 2007) were searched.
Randomised controlled trials of psychological treatment for chest pain with normal coronary anatomy were searched for. The diagnosis included was: non-specific chest pain, atypical chest pain, syndrome X, or chest pain with normal coronary anatomy. The author and the project advisor assessed the titles and abstracts of the studies for inclusion.
Nine clinical studies were included. The interventions were cognitive behavioural therapy (n=6), hypnotherapy (n=1), relaxation and training therapy (n=1) and breathing retraining (n=1), with a total of 310 participants. For the primary outcome measure of chest pain, a significant improvement after treatment was reported in all but one study. For the secondary outcome measure of psychological morbidity, significant improvement after treatment was reported in seven of the nine studies. However the effect on psychological morbidity was not maintained at follow up. For health related quality of life, significant improvements were reported and the effect was maintained at follow up.
Psychological intervention for treating non-specific chest pain was moderately effective regarding chest pain reduction. All studies of cognitive behavioural therapy reported significant short term effects on chest pain. However, further studies are required to determine long-term efficacy and address methodological limitations in previous studies.