[Psychosomatic medicine for non-cardiac chest pain].
Recently, it has become problematic that the number of noncardiac chest pain (NCCP) patients are increasing among those who come to the emergency room with chest pain as a chief complaint. They tend to come to hospitals often and over many years, even after cardiac-chest pain has been excluded from their diagnosis. Moreover, studies have shown that NCCP patients have a high prevalence of anxiety, depression and disability. However, most NCCP patients are usually treated by cardiologists or primary physicians. Ordinary biomedical approaches often fail to treat NCCP. NCCP is one of the most important functional somatic syndromes from the view of medical economics. The cause of NCCP includes gastroesophageal reflux disease, panic disorder and esophageal dysmotility. In this review article, we summarize the definition, epidemiology, pathology, and process of diagnosis of NCCP. Finally, we propose a pathological hypothesis from a psychosomatic view. We discuss the effects of anxiety, fear and hyperactive behavior induced by affective stressors on the dysmotility and the lowering of the pain threshold.
Funakoshi
Seiko
S
Department of Psychosomatic Medicine, Graduate School of Medicine, Kyushu University.
Hosoi
Masako
M
Tsuchida
Osamu
O
D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D001007:Anxiety / Q000150:complications; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology / Q000523:psychology / Q000628:therapy; D015154:Esophageal Motility Disorders / Q000150:complications; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D006967:Hypersensitivity / Q000150:complications; D008875:Middle Aged; D011611:Psychosomatic Medicine / Q000379:methods; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use
D014151:Anti-Anxiety Agents; D000929:Antidepressive Agents, Tricyclic; D002121:Calcium Channel Blockers; D017367:Selective Serotonin Reuptake Inhibitors