368: Psychological interventions may be effective for non-cardiac chest pain

November 03, 2012

PEARLS 368, September 2012, written by Brian R McAvoy

Clinical question: How effective are psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy?

Bottom line: Psychological treatments, especially cognitive behavioural therapy and hypnotherapy, may be effective in terms of reduced chest pain frequency in the short term (up to 3 months) for the treatment of non-specific chest pain. The evidence for brief interventions was less clear. No adverse effects of psychotherapy were found.

Caveat: The benefits of treatment were not sustained beyond 3 months. There was no effect on the severity of the chest pain. The evidence was limited to small trials of questionable quality.

Context: Recurrent chest pain in the absence of coronary artery disease is a common, difficult-to-treat problem that can lead 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 artery anatomy. Cochrane Reviews, 2012, Issue 6. Arti.cle No. CD004101DOI: 10.1002/14651858.CD004101.pub4. This review contains 15 studies involving 803 participants.

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