Positive Health Online

Abstract

POTTS and colleagues, University Department of Psychiatry, Royal Edinburgh Hospital UK used a psychological treatment regime to treat patients with chest pain despite normal cardiac measures .

Background

Methodology

60 patients with continuing chest pain and who had normal angiography had a psychological treatment package, consisting of education, relaxation, breathing training, graded exposure to activity and exercise and challenging automatic thoughts about heart disease . The treatment was delivered in 6 sessions over 8 weeks for groups of up to 6 patients. Patients maintained daily records of chest pain episode frequency and nitrate use. Questionnaires assessed anxiety, depression and disability. Exercise tolerance was assessed using treadmill electrocardiography, and assessment of hyperventilation was carried out capnographically. The results of these patients were compared to waiting-list controls.

Results

The psychological treatment regimes significantly reduced chest pain episodes from a median 6.5 to 2.5 per week . There were significant improvements in anxiety and depression scores, disability rating and exercise tolerance, which were maintained at 6-month follow-up. The treatment reduced hyperventilation prevalence from 54% to 34%, but not the prevalence of ECG-positive exercise tests. Those patients who continued to attribute their pain to heart disease had poorer outcomes.

Conclusion

Group psychological treatment for non-cardiac chest pain is feasible, reduces pain, psychological morbidity, disability and improves exercise tolerance .

References

Potts SG et al. Group psychological treatment for chest pain with normal coronary arteries. Qjm 92(2): 81-6 Feb 1999.