title: Psychological interventions for symptomatic management of non-specific chest pain in patients with normal coronary anatomy.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To investigate psychological treatments for non-specific chest pain (NSCP) with normal coronary anatomy.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2008, Issue 4), MEDLINE (1966 to December 2008), CINAHL (1982 to December 2008) EMBASE (1980 to December 2008), PsycINFO (1887 to December 2008), the Database of Abstracts of Reviews of Effectiveness (DARE) and Biological Abstracts (January 1980 to December 2008). We also searched citation lists and approached authors.
  
  
  METHODS
  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, atypical chest pain, syndrome X, or chest pain with normal coronary anatomy (as either inpatients or outpatients).
  
  
  METHODS
  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.
  
  
  RESULTS
  Ten RCTs (484 participants) were included. There was a significant reduction in reports of chest pain in the first three months following the intervention; fixed effects relative risk = 0.68 (95% CI 0.57 to 0.81). This was maintained from 3 to 9 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 (mean difference = -1.73 (95% CI -2.21 to -1.26)) and severity (mean difference = -6.86 (95% CI -10.74 to -2.97)). 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: The University of Queensland, Queensland Centre for Health Data Services, Room 518(A) McGregor Building (No 64), Brisbane, Queensland, Australia, Qld 4072.
authors.forename: Steve R
authors.initials: SR
authors.lastname: Kisely
authors.forename: Leslie Anne
authors.initials: LA
authors.lastname: Campbell
authors.forename: Paul
authors.initials: P
authors.lastname: Skerritt
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Yelland
mesh_terms: D001521:Behavior Therapy; D002637:Chest Pain / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D006801:Humans; D006990:Hypnosis; D017566:Microvascular Angina / Q000523:psychology / Q000628:therapy*; D011613:Psychotherapy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence