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| |  Study Examines Course and Treatment of Unexplained Chest Pain CHICAGO -- February 9, 2010 -- Fewer than half of individuals who have “non-specific” chest pain experience relief from symptoms following standard medical care, according to a study published in the February 8 issue of Archives of Internal Medicine. In addition, one-tenth of those with persistent chest pain undergo potentially unnecessary diagnostic testing. More than half of patients with chest pain are classified as not having an underlying heart condition, according to background information in the article. Some have another well-established medical condition, such as upper respiratory tract infection, but for many no pathophysiologic cause can be found. Such non-specific chest pain “is a frequent phenomenon in primary care,” the authors wrote. “However, knowledge about the course and outcome of this condition is sparse.” Julia Anna Glombiewski, PhD, Philipps-University of Marburg, Marburg, Germany, and colleagues studied 807 patients (mean age 57.6 y) with non-specific chest pain who visited 74 German primary care offices in 2005 and 2006. The clinicians recorded their preliminary diagnoses, along with any investigations and treatments related to their patients’ chest pain. Patients were contacted by phone 6 weeks and then 6 months after the initial consultation. Among the 755 study patients who provided data at the 6 month follow-up, 419 (55.5%) still had chest pain. In addition, 45 (10.7%) of those were categorised as using healthcare in an inappropriate manner, defined as 2 or more visits to a cardiologist or 3 or more cardiac diagnostic evaluations -- including angiograms and electrocardiograms -- within 6 months. This compared with 24 (7.1%) of 336 patients with remitted chest pain. Only 6 patients (<2%) were referred to mental health specialists for ongoing chest pain. “This finding is surprising because psychological factors are known to contribute to the development of chronic pain, and psychological consultations are covered by the health care system in Germany,” the authors wrote. “Patients with psychologically caused non-specific chest pain showed more problematic health are -- seeking behaviour but were rarely referred to mental health professionals. Patients, general practitioners or both seem to be hesitant to involve psychological interventions.” The findings help explain the high prevalence of chest pain in the general population, the authors concluded. “Future research should investigate the development of effective interventions for non-specific chest pain and their implementation within health care systems.”
SOURCE: Archives of Internal Medicine
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