title: A multidisciplinary, biopsychosocial treatment for non-cardiac chest pain.
abstract: BACKGROUND
  Non-cardiac chest pain (NCCP) affects up to 80% of patients attending chest pain clinics, but its treatment is suboptimal.
  
  
  OBJECTIVE
  To describe the outcomes of a pilot, stepped care, biopsychosocial management programme in terms of improvements in chest pain, psychosocial scores and use of healthcare resources.
  
  
  METHODS
  Of 198 referrals, 77 patients were suitable for the clinic and received a one hour biopsychosocial assessment. Stepped care consisted of assessment only, low intensity Cognitive Behaviour Therapy (CBT), or high intensity CBT.
  
  
  RESULTS
  The proportion with pain occurring more than once monthly fell from 100% at baseline to 61% at 3 months (p < 0.001). Pain interference reduced significantly (p < 0.001) from 5.9 [SD 2.2] at baseline to 3.2 [SD 2.6] at 3 months. Depression scores improved from a mean 8.8 to 5.4 (p < 0.05) and anxiety from 6.9 to 4.6 (p < 0.05). Use of healthcare resources improved with a fall in consultations for chest pain over 6 months from a mean 2.6 to 0.1 (p < 0.05). The impact on work and social functioning reduced from 10.4 [SD 10.4] to 3.9 [SD 7.5]: [t (70) = 6.3, p < 0.001). Further improvements occurred at 6 months for chest pain frequency (which fell to 51%, p = 0.003), interference (2.6 [SD 2.1], p < 0.05) and avoidance of exercise (p = 0.03). Otherwise improvements were maintained between 3 and 6 months.
  
  
  CONCLUSIONS
  A stepped-care biopsychosocial approach to NCCP is effective in reducing chest pain frequency and improving behaviour and wellbeing. It can be delivered in part by a nurse allowing integration into any chest pain clinic.
authors.affiliation: Cardiothoracic Centre, Guy's and St Thomas Hospital, London, UK.
authors.forename: J B
authors.initials: JB
authors.lastname: Chambers
authors.affiliation: Cardiothoracic Centre, Guy's and St Thomas Hospital, London, UK.|Department of Psychology, Institute of Psychiatry, King's College London, London, UK.
authors.forename: E M
authors.initials: EM
authors.lastname: Marks
authors.affiliation: Cardiothoracic Centre, Guy's and St Thomas Hospital, London, UK.
authors.forename: V
authors.initials: V
authors.lastname: Russell
authors.affiliation: Department of Psychology, Institute of Psychiatry, King's College London, London, UK.
authors.forename: M S
authors.initials: MS
authors.lastname: Hunter
mesh_terms: D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000150:complications / Q000628:therapy; D002637:Chest Pain / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000150:complications / Q000628:therapy; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D018710:Pain Clinics; D013315:Stress, Psychological / Q000150:complications / Q000628:therapy*