Top

Journal of Clinical Psychology in Medical Settings

Published in:

01-09-2013

Quality of Life in Patients with Non-CAD Chest Pain: Associations to Fear of Pain and Psychiatric Disorder Severity

Authors: Katherine Hadlandsmyth, Kamila S. White, Ronald J. Krone

Published in: Journal of Clinical Psychology in Medical Settings | Issue 3/2013

Abstract

Chest pain in the absence of identified cardiac cause, or non-cardiac chest pain (NCCP), is a common condition that may result in impaired quality of life. Theories of NCCP put forward that patients who react to cardiopulmonary sensations with fear may avoid activities that elicit cardiac sensations. Co-morbid psychiatric disorders, which are prevalent in this population, may predispose individuals to be more vigilant to physiological sensations, including cardiac-related symptoms. The daily impact of avoiding cardiopulmonary cues may limit quality of life. This study examined psychiatric disorders, fear of pain, and quality of life in 30 non-coronary artery disease (CAD) chest pain patients. Psychiatric disorder severity was independently associated with mental health related quality of life and fear of pain was independently associated with physical health related quality of life. This research adds understanding to contributory factors to impaired quality of life among patients with non-CAD chest pain.

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.

Aikens, J. E., Michael, E., Levin, T., & Lowery, E. (1999). The role of cardioprotective avoidance beliefs in noncardiac chest pain and associated emergency department utilization. Journal of Clinical Psychology in Medical Settings, 6, 317–332. doi:10.1023/A:1026267113458.CrossRef

Aikens, J. E., Zvolensky, M. J., & Eifert, G. H. (2001). Differential fear of cardiopulmonary sensations in emergency room noncardiac chest pain patients. Journal of Behavioural Medicine, 24, 155–167. doi:10.1023/A:1010710614626.CrossRef

Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (2nd ed.). New York: Guilford Press.

Bass, C. M., & Wade, C. (1984). Chest pain with normal coronary arteries: A comparative study of psychiatric and social morbidity. Psychological Medicine, 14, 51–61. doi:10.1017/S003329170000307X.PubMedCrossRef

Bass, C. M., Wade, C., Hand, D., & Jackson, G. (1983). Patients with angina with normal and near normal coronary arteries: Clinical and psychosocial state 12 months after angiography. British Medical Journal, 287, 1505–1508. doi:10.1136/bmj.287.6404.1505.PubMedCrossRef

Beitman, B. D., Mukerji, V., Lamberti, J. W., Schmid, L., DeRosear, L., Kushner, M., et al. (1989). Panic disorder in patients with chest pain and angiographically normal coronary arteries. American Journal of Cardiology, 63, 1399–1403. doi:10.1016/0002-9149(89)91056-4.PubMedCrossRef

Biggs, A. M., Aziz, Q., Tomenson, B., & Creed, F. (2004). Effect of childhood adversity on health related quality of life in patients with upper abdominal or chest pain. Gut, 53, 180–186. doi:10.1136/gut.2003.020974.PubMedCrossRef

Bradley, L. A., Scarinci, I. C., & Richter, J. E. (1991). Pain threshold levels and coping strategies among patients who have chest pain and normal coronary arteries. Medical Clinics of North America, 75, 1189–1202.PubMed

Brown, T. A., Campbell, L. A., Lehman, C. L., Grisham, J. R., & Mancill, R. B. (2001). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology, 110, 585–599. doi:10.1037/0021-843X.110.4.585.PubMedCrossRef

Bugiardini, R., & Bairey Merz, C. N. (2005). Angina with “normal” coronary arteries: A changing philosophy. JAMA, 293, 477–484.PubMedCrossRef

Dammen, T., Ekeberg, O., Arnesen, H., & Friis, S. (2008). Health-related quality of life in non-cardiac chest pain patients with and without panic disorder. International Journal of Psychiatry in Medicine, 38, 271–286. doi:10.2190/PM.38.3.d.PubMedCrossRef

Di Nardo, P. A., Brown, T. A., & Barlow, D. H. (1994). Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version. San Antonio, TX: Graywind Publications Inc.

Ehde, D. M., & Jensen, M. P. (2004). Feasibility of a cognitive restructuring intervention for treatment of chronic pain in persons with disabilities. Rehabilitation Psychology, 49, 254–258. doi:10.1037/0090-5550.49.3.254.CrossRef

Eifert, G. H., Hodson, S. E., Tracey, D. R., Seville, J. L., & Gunawardane, K. (1996). Heart-focused anxiety, illness beliefs, and behavioral impairment: Comparing heart-anxious patients with cardiac and surgical inpatients. Journal of Behavioral Medicine, 19, 385–399. doi:10.1007/BF01904764.PubMedCrossRef

Eifert, G. H., Zvolensky, M. J., & Lejuez, C. W. (2000). Heart-focused anxiety and chest pain: A conceptual and clinical review. Clinical Psychology: Science and Practice, 7, 403–417.CrossRef

Eslick, G. D. (2007). Quality of life. In R. Fass & G. D. Eslick (Eds.), Non-cardiac chest pain: A growing medical problem. San Diego, CA: Plural Publishing Incorporated.

Eslick, G. D., Coulshed, D. S., & Talley, N. J. (2002). The burden of illness of non-cardiac chest pain. Alimentary Pharmacology and Therapeutics, 16, 1217–1223.PubMedCrossRef

Eslick, G. D., Jones, M. P., & Talley, N. J. (2003). Non-cardiac chest pain: Prevalence, risk factors, impact and consulting—A population-based study. Alimentary Pharmacology and Therapeutics, 17, 1115–1124. doi:10.1046/j.1365-2036.2003.01557.x.PubMedCrossRef

Eslick, G. D., & Talley, N. J. (2008). Natural history and predictors of outcome for non-cardiac chest pain: A prospective 4-year cohort study. Neurogastroenterology and Motility, 20, 989–997.PubMedCrossRef

Eslick, G. D., Talley, N. J., Young, L. J., & Jones, M. P. (1999). Non-cardiac chest pain in the population: Prevalence and impact. Journal of Gastroenterology and Hepatology, 14, A179 (Abstract).

Failde, I., & Ramos, I. (2000). Validity and reliability of the SF-36 health survey questionnaire in patients with coronary artery disease. Journal of Clinical Epidemiology, 53, 359–365.PubMedCrossRef

Fleet, R. P., & Beitman, B. D. (1997). Unexplained chest pain: When is it panic disorder? Clinical Cardiology, 20, 187–194. doi:10.1002/clc.4960200303.PubMedCrossRef

Fredheim, O. M., Borchgrevink, P. C., Saltnes, T., & Kaasa, S. (2007). Validation and comparison of the health-related quality-of-life instruments EORTC QLQ-C30 and SF-36 in assessment of patients with chronic nonmalignant pain. Journal of Pain and Symptom Management, 34, 657–665. doi:10.1016/j.jpainsymman.2007.01.011.PubMedCrossRef

Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: Scientific advances and future directions. Psychological Bulletin, 133, 581–624. doi:10.1037//0033-2909.133.4.581.PubMedCrossRef

Hamer, M., Molloy, G. J., & Stamatakis, E. (2008). Psychological distress as a risk factor for cardiovascular events: pathophysiological and behavioral mechanisms. Journal of the American College of Cardiology, 52, 2156–2162. doi:10.1016/j.jacc.2008.08.057.PubMedCrossRef

Hays, R. D., & Morales, L. S. (2001). The RAND-36 measure of health-related quality of life. Annals of Medicine, 33, 350–357. doi:10.3109/07853890109002089.PubMedCrossRef

Husser, D., Bollmann, A., Kuhne, C., Molling, J., & Klein, H. U. (2006). Evaluation of noncardiac chest pain: Diagnostic approach, coping strategies and quality of life. European Journal of Pain, 10, 51–55. doi:10.1016/j.ejpain.2005.01.011.PubMedCrossRef

Jakle, K. R., White, K. S., Covino, N. A., & Gervino, E. V. (2009). Quality of life outcomes and psychiatric morbidity in non-cardiac chest pain patients. Unpublished manuscript. Boston, MA: Boston University.

Jonsbu, E., Dammen, T., Morken, G., Moum, T., & Martinsen, E. W. (2011). Short-term cognitive behavioral therapy for non-cardiac chest pain and benign palpitations: A randomized controlled trial. Journal of Psychosomatic Research, 70, 117–123.PubMedCrossRef

Keefe, F. J., Shelby, R. A., Somers, T. J., Varia, I., Blazing, M., Waters, S. J., et al. (2011). Effects of coping skills training and sertraline in patients with non-cardiac chest pain: A randomized controlled study. Pain, 152, 730–741.PubMedCrossRef

Kisely, S. R., Campbell, L. A., Skerritt, P., & Yelland, M. J. (2010). Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy. Cochrane Database of Systematic Reviews, 1, CD004101. doi:10.1002/14651858.CD004101.pub3.

Lampe, F. C., Whincup, P. H., Wannamethee, S. G., Ebrahim, S., Walker, M., & Shaper, A. G. (1998). Chest pain on questionnaire and prediction of major ischaemic heart disease events in men. European Heart Journal, 19, 63–73. doi:10.1053/euhj.1997.0729.PubMedCrossRef

Locke, G. R., 3rd, Talley, N. J., Fett, S. L., Zinsmeister, A. R., & Melton, L. J., I. I. I. (1997). Prevalence and clinical spectrum of gastroesophageal reflux: A population-based study in Olmsted County, Minnesota. Gastroenterology, 112, 1448–1456. doi:10.1016/S0016-5085(97)70025-8.PubMedCrossRef

Marquis, P., Fayol, C., Joire, J. E., & Leplege, A. (1995). Psychometric properties of a specific quality of life questionnaire in angina pectoris patients. Quality of Life Research, 4, 540–546. doi:10.1007/BF00634749.PubMedCrossRef

Mayou, R. (1998). Chest pain, palpitations and panic. Journal of Psychosomatic Research, 44, 53–70. doi:10.1016/S0022-3999(97)00209-2.PubMedCrossRef

McCracken, L. M., Gross, R. T., & Eccleston, C. (2002). Multimethod assessment of treatment process in chronic low back pain: Comparison of reported pain-related anxiety with directly measured physical capacity. Behaviour Research and Therapy, 40, 585–594.PubMedCrossRef

McCracken, L. M., & Thompson, M. (2011). Psychological advances in chronic pain: A concise selective review of research from 2010. Current Opinion in Supportive and Palliative Care, 5, 122–126. doi:10.1097/SPC.0b013e328345a3ff.PubMedCrossRef

McCracken, L. M., Zayfert, C., & Gross, R. T. (1992). The Pain Anxiety Symptoms Scale: Development and validation of a scale to measure fear of pain. Pain, 50, 67–73. doi:10.1016/0304-3959(92)90113-P.PubMedCrossRef

Mitchell, B. D., Hazuda, H. P., Haffner, S. M., Patterson, J. K., & Stern, M. P. (1991). High prevalence of angina pectoris in Mexican-American men. A population with reduced risk of myocardial infarction. Annals of Epidemiology, 1, 415–426. doi:10.1016/1047-2797(91)90011-Z.PubMedCrossRef

Noto, T. J., Jr., Johnson, L. W., Krone, R., Weaver, W. F., Clark, D. A., Kramer, J. R., Jr., et al. (1991). Cardiac catheterization 1990: A report of the registry of the society for cardiac angiography and interventions (SCA&I). Catheterization and Cardiovascular Diagnosis, 24, 75–83. doi:10.1002/ccd.1810240202.PubMedCrossRef

Osman, A., Barrios, F. X., Osman, J. R., Schneekloth, R., & Troutman, J. A. (1994). The Pain Anxiety Symptoms Scale: Psychometric properties in a community sample. Journal of Behavioral Medicine, 17, 511–522. doi:10.1007/BF01857923.PubMedCrossRef

Roelofs, J., McCracken, L., Peters, M. L., Crombez, G., van Breukelen, G., & Vlaeyen, J. W. S. (2004). Psychometric evaluation of the Pain Anxiety Symptoms Scale (PASS) in chronic pain patients. Journal of Behavioral Medicine, 27, 167–183. doi:10.1023/B:JOBM.0000019850.51400.a6.PubMedCrossRef

Shelby, R. A., Somers, T. J., Keefe, F. J., Silva, S. G., McKee, D. C., She, L., et al. (2009). Pain catastrophizing in patients with noncardiac chest pain: Relationships with pain, anxiety, and disability. Psychosomatic Medicine, 71, 861–868. doi:10.1097/PSY.0b013e3181b49584.PubMedCrossRef

Sheps, D. S., Creed, F., & Clouse, R. E. (2004). Chest pain in patients with cardiac and non-cardiac disease. Psychosomatic Medicine, 66, 861–867.PubMedCrossRef

Spinhoven, P., Van der Does, A. J. W., Van Dijk, E., & Van Rood, Y. R. (2010). Heart-focused anxiety as a mediating variable in the treatment of noncardiac chest pain by cognitive-behavioral therapy and paroxetine. Journal of Psychosomatic Research, 69, 227–235. doi:10.1016/j.jpsychores.2010.02.005.PubMedCrossRef

Stein, D. S. (2009). Psychological and sociodemographic factors in the non-cardiac chest pain patient impacting performance on the cardiac stress test. Dissertation Abstracts International: Section B: The Sciences and Engineering, 69, 4447.

Teper, E., & O’Brien, J. T. (2008). Vascular factors and depression. International Journal of Geriatric Psychiatry, 23, 993–1000. doi:10.1002/gps.2020.PubMedCrossRef

Van Peski-Oosterbaan, A. S., Spinoven, P., Van der Does, A. J. W., Bruschke, A. V. G., & Rooijmans, H. G. M. (1999). Cognitive change following cognitive behavioral therapy for non-cardiac chest pain. Psychotherapy and Psychosomatics, 68, 214–220. doi:10.1159/000012335.PubMedCrossRef

von Kanel, R. (2008). Psychological distress and cardiovascular risk: What are the links? Journal of the American College of Cardiology, 52, 2163–2165. doi:10.1016/j.jacc.2008.09.015.CrossRef

Ware, J. E., Jr., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30, 473–483. doi:10.1097/00005650-199206000-00002.PubMedCrossRef

White, K. S., Craft, J. M., & Gervino, E. V. (2010). Anxiety and hypervigilance to cardiopulmonary sensations in non-cardiac chest pain patients with and without psychiatric disorders. Behaviour Research and Therapy, 48, 394–401. doi:10.1016/j.brat.2010.01.001.PubMedCrossRef

White, K. S., & Raffa, S. D. (2004). Anxiety and other emotional factors in noncardiac chest pain. Mental Fitness, 3, 60–67.

White, K. S., Raffa, S. D., Jakle, K. R., Stoddard, J. A., Barlow, D. H., Brown, T. A., et al. (2008). Morbidity of DSM-IV Axis I disorders in patients with noncardiac chest pain: Psychiatric morbidity linked with increased pain and health care utilization. Journal of Consulting and Clinical Psychology, 76, 422–430. doi:10.1037/0022-006X.76.3.422.PubMedCrossRef

White, K. S., & Rosenbaum, D. L. (in press). Psychological aspects: Diagnosis and management. In J. C. Kaski, G. D. Eslick, & C. N. Bairey-Merz (Eds.), Chest pain and normal coronary arteries: A multidisciplinary approach. New York: Springer.

Williams, A., & McCracken, L. M. (2004). Cognitive behavioral therapy for chronic pain: An overview with specific reference to fear and avoidance. In G. J. Amundson, J. W. S. Vlaeyen, & G. Crombez (Eds.), Understanding and treating fear of pain (pp. 293–312). Oxford, England: Oxford University Press.

Wong, W. M., Lai, K. C., Lau, C. P., Hu, W. H., Chen, W. H., Wong, B. C., et al. (2002). Upper gastrointestinal evaluation of Chinese patients with non-cardiac chest pain. Alimentary Pharmacology and Therapeutics, 16, 465–471.PubMedCrossRef

Title: Quality of Life in Patients with Non-CAD Chest Pain: Associations to Fear of Pain and Psychiatric Disorder Severity
Authors: Katherine Hadlandsmyth
Kamila S. White
Ronald J. Krone
Publication date: 01-09-2013
Publisher: Springer US
Published in: Journal of Clinical Psychology in Medical Settings / Issue 3/2013
Print ISSN: 1068-9583
Electronic ISSN: 1573-3572
DOI: https://doi.org/10.1007/s10880-012-9347-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Quality of Life in Patients with Non-CAD Chest Pain: Associations to Fear of Pain and Psychiatric Disorder Severity

Abstract

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 3/2013

Integrating Mental Health Services into a General Hospital in Puerto Rico

Adolescents with Poorly Controlled Type 1 Diabetes can Benefit from Coaching: A Case Report and Discussion

Treatment Effectiveness of a Brief Behavioral Intervention for Preschool Disruptive Behavior

Assessment of Identity and Quality of Life in Diabetic and Renal Transplant Adolescents in Comparison to Healthy Adolescents

Psychometric Properties of the Primary Care Behavioral Health Screen

Quality of Life in Women Following Various Surgeries of Body Manipulation: Organ Transplantation, Mastectomy, and Breast Reconstruction