Non-Cardiac Chest Pain as a Persistent Physical Symptom: Psychological Distress and Workability.

Non-Cardiac Chest Pain (NCCP) is persistent chest pain in the absence of identifiable cardiac pathology. Some NCCP cases meet criteria for Persistent Physical Symptoms (PPS), where the symptoms are both persistent and distressing/disabling. This study aimed to identify patients that might need specialist treatment for PPS by examining cases of NCCP that meet PPS criteria. We analysed data from 285 chest pain patients that had received an NCCP diagnosis after attending an emergency cardiac department. We compared NCCP patients who did and did not meet the additional criteria for heart-related PPS and hypothesised that the groups would differ in terms of psychological variables and workability. We determined that NCCP patients who meet PPS criteria were more likely than other NCCP patients to be inactive or unable to work, reported more general anxiety and anxiety about their health, were more depressed, ruminated more, and, importantly, had a higher number of other PPS. A high proportion of NCCP patients meet PPS criteria, and they are similar to other PPS patients in terms of comorbidity and disability. This highlights the importance of focusing psychological interventions for this subgroup on the interplay between the range of physical and psychological symptoms present.

[Non-cardiac chest pain and its association with persistent chest pain and poor mental well-being].

INTRODUCTION: An estimated 50-75% of visits to cardiac emergency departments are due to chest pain which is non-cardiac in nature (non-cardiac chest pain (NCCP). This study evaluates the prevalence of NCCP in the emergency departments at Landspitali, and assesses its association with continued chest-pain post discharge, mental well--being and the information-provision provided to NCCP patients during hospitalization. MATERIAL AND METHODS: Participants were 390 patients (18-65 years) presenting with chest pain to the cardiac emergency or the general emergency department at Landspitali from October 2015-May 2016. Measurements included questionnaires assessing somatic symptoms, mental well-being and quality of life, and questions regarding continued chest-pain and information-provision during hospitalization. RESULTS: In total 72% of participants (282) were considered having NCCP while 24% (92) had cardiac disease. NCCP patients experienced a similar burden of somatic and depressive symptoms, but slightly more anxiety and mental distress than cardiac patients. Equal proportions (60%) of NCCP and cardiac patients reported having experienced chestpain post discharge. Continued chest-pain was, however, associated with greater anxiety (ß=0.18, p<0.001) and depression (ß=0.18, p<0.003) among NCCP patients. Thirty percent of NCCP patients lacked instructions of how to respond to continued chest-pain and only 40% received information regarding other possible causes of chest pain. CONCLUSION: NCCP was prevalent among patients presenting to emergency departments at Landspitali. The majority of NCCP patients experienced continued chest-pain after discharge, and such pain experience was associated with mental distress. A third of NCCP patients lacked information about possible causes for the pain and advice about coping with symptoms.