485 Psychological interventions may benefit non-specific chest pain management

August 25, 2016

written by Brian R McAvoy.

Clinical Question
How effective are psychological interventions in the management of non-specific chest pain in patients with normal coronary anatomy?

Bottom Line
Psychological treatments, especially cognitive behavioural therapy and hypnotherapy, might be effective in the short-term (<three months) for the treatment of patients with non-specific chest pain. There was a significant reduction in the frequency but not the severity of chest pain. There was also a significant increase in the number of chest pain-free days.

The evidence was limited to small trials with high heterogeneity, reflected in a wide range of outcome measures.


Recurrent chest pain in the absence of coronary artery disease is a common, difficult to treat problem that sometimes leads to excess use of medical care. A substantial number of patients are not reassured by negative medical assessment, reporting persistent pain and limitations. Psychological factors appear to be of importance for treatment.

Cochrane Systematic Review
Kisely SR et al. Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy. Cochrane Reviews, 2015, Issue 6. Art. No.: CD004101.DOI: 10.1002/14651858. CD004101.pub5. This review contains 17 studies involving 1,006 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.