Unexplained chest pain, also known as non-cardiac chest pain (NCCP) is often indistinguishable from ischaemic heart pain. The pain may be characterised by a squeezing or burning substernal chest pain and may radiate to parts of the body such as the back, neck, arms and jaw. It is also identical to cardiac-related chest pain.

Although gastroesophageal reflux disease has been cited as the most common cause of NCCP, research has also shown the link between NCCP and several psychological co-morbidities.

The prevalence of psychological disorders such as panic disorder, anxiety, and depression in NCCP patients have been reported in several studies.

Patients with anxiety more likely to have chest pain

N. S. Demiryoguran and several other researchers at Dokuz Eylul University in Turkey conducted a study on 157 patients in 2006, investigating patients aged between 18 and 65 who had been diagnosed with non-specific chest pain.

It was found that 49 patients with a high score on the Hospital Anxiety and Depression Scale (HADS) anxiety subscale had a higher frequency of associated symptoms.

Of these, 33 patients were interviewed by a psychiatrist and 23 were diagnosed with anxiety disorder. Patients with high anxiety scores more frequently reported dizziness or light-headedness, chills or hot flushes, and fear of dying.

Lifestyle factors may contribute to chest pains

A 2009 study conducted in Sweden found that stress at work, anxiety, depression and a sedentary lifestyle are common factors affecting those with unexplained chest pains. Conducted by Annika Janson Fagring from the University of Gothenburg, the study also analysed patients’ symptoms and their influence on everyday life.

Findings showed that both men and women with unexplained chest pain faced more stress at work, experienced symptoms of depression and trait anxiety, as well as had less social interaction.

It was also observed that women with unexplained chest pains presented more symptoms of depression and trait anxiety compared to men.

Chest pain in children also linked to psychological factors

Psychological factors have been discovered to have a significant impact on chest pain among children as well. Jennifer L. Lee, together with other researchers from the University of Georgia, found that anxiety and depression were higher in NCCP paediatric patients compared to those diagnosed with innocent heart murmurs.

In addition to reporting symptoms of anxiety, the 2012 study found that children experiencing NCCP also had feelings of tension and restlessness. These children also tended to demonstrate a higher level of functional disability, such as being less involved in extracurricular activities.

Management methods and proper treatment important

Acknowledging the significance of how psychological distress can play a role in NCCP is important, as several studies have demonstrated that it may also affect the patients’ quality of life.

In an article published in 2002, authors Christopher Bass and Richard Mayou emphasised the need for the management of NCCP to be flexible. This is because patients not only vary in severity of symptoms and associated disability, but also in their need for explanation and treatment of physical and psychological problems.

Besides general management methods such as proper explanation of the diagnosis, advice on behaviour and treatment, specialist treatments may also be needed. These treatments include cognitive behavioural therapy, the use of antidepressant drugs and psychosocial intervention for associated difficulties to aid the management of the condition. MIMS

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