Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy (Review)

Kisely, Steve R., Campbell, Leslie A., Yelland, Michael J. and Paydar, Anita (2012) Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy (Review). Cochrane Database of Systematic Reviews, 6 6: CD004101-1-CD004101-66. doi:10.1002/14651858.CD004101.pub4

Author Kisely, Steve R.
Campbell, Leslie A.
Yelland, Michael J.
Paydar, Anita
Title Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy (Review)
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2012
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD004101.pub4
Open Access Status
Volume 6
Issue 6
Start page CD004101-1
End page CD004101-66
Total pages 66
Place of publication Oxford, United Kingdom
Publisher John Wiley and Sons
Collection year 2012
Language eng
Formatted abstract
Recurrent chest pain in the absence of coronary artery disease is a common problem that sometimes leads to excess use of medical care.  Although many studies examine the causes of pain in these patients, few clinical trials have evaluated treatment. The studies reviewed  in this paper provide an insight into the effectiveness of psychological interventions for this group of patients.
To update the previously published systematic review.
We searched the Cochrane LIbrary (CENTRAL andDARE) (Issue 3 of 4 2011),MEDLINE (1966 to AugustWeek 5, 2011), CINAHL
(1982 to Sept 2011) EMBASE (1980 to Week 35 2011), PsycINFO (1887 to Sept Week 1, 2011), and Biological Abstracts (January 1980 to Sept 2011). We also searched citation lists and approached authors.
Randomised controlled trials (RCTs) with standardised outcome methodology that tested any form of psychotherapy for chest pain with normal anatomy. Diagnoses included non-specific chest pain (NSCP), atypical chest pain, syndrome X, or chest pain with normal coronary anatomy (as either inpatients or outpatients).
Two authors independently selected studies for inclusion, extracted data and assessed quality of studies. The authors contacted trial authors for further information about the RCTs included.
Six new RCTs were located and added to the existing trials, therefore, a total of 15 RCTs (803 participants) were included. There was a significant reduction in reports of chest pain in the first three months following the intervention; fixed-effect relative risk = 0.68 (95% CI 0.57 to 0.81). This was maintained from three to nine months afterwards; relative risk = 0.59 (95% CI 0.45 to 0.76). There was also a significant increase in the number of chest pain free days up to three months following the intervention; mean difference = 2.81 (95% CI 1.28 to 4.34). This was associated with reduced chest pain frequency (random-effects mean difference = -2.26 95% CI -4.41
to -0.12) but there was no evidence of effect of treatment on chest pain frequency from three to twelve months (random-effects mean difference -0.81 95% CI -2.35, 0.74). There was no effect on severity (random-effects mean difference = -4.64 (95% CI -12.18 to 2.89) up to three months after the intervention. Overall there was generally a low risk of bias, however, there was high heterogeneity and caution is required in interpreting these results. Wide variability in outcome measures made integration of studies for secondary outcome measures difficult to report on.
This review suggests a modest to moderate benefit for psychological interventions, particularly those using a cognitive-behavioural framework, which was largely restricted to the first three months after the intervention. Hypnotherapy is also a possible alternative.  The evidence for brief interventions was less clear. Further RCTs of psychological interventions for NSCP with follow-up periods of at least 12 months are needed.
Keyword Behavior Therapy
Chest pain [psychology; therapy]
Cognitive therapy
Psychotherapy [methods]
Q-Index Code CX
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published Online: 13 JUN 2012

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Non HERDC
School of Public Health Publications
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