Cognitive-perceptual factors in noncardiac chest pain and cardiac chest pain

• Published in: Psychosomatic medicine 2012-10, Vol.74 (8), p.861-868
• Main Authors: Schroeder, Stefanie, Achenbach, Stephan, Körber, Stephanie, Nowy, Kerstin, de Zwaan, Martina, Martin, Alexandra
• Format: Article
• Language: English
• Subjects: Adult; Aged; Angina Pectoris - diagnosis; Angina Pectoris - psychology; Anxiety; Attitude to Health; Chest pain; Chest Pain - diagnosis; Chest Pain - etiology; Chest Pain - psychology; Cognition; Coronary Angiography; Emotional disorders; Female; Health care expenditures; Health problems; Humans; Indexing in process; Logistic Models; Male; Medical diagnosis; Middle Aged; Multivariate Analysis; Pain; Pain Measurement; Pain Perception; Perception; Perceptions; Psychological aspects; Psychosomatic medicine; Risk factors; Sensitivity; Surveys and Questionnaires
• ISSN: 0033-3174; 1534-7796
• DOI: 10.1097/PSY.0b013e31826ae4ae

Noncardiac chest pain (NCCP) is a common condition associated with considerable patient distress and substantial healthcare costs. Our aim was to investigate associations between illness perceptions, anxiety sensitivity, somatic amplification, and experience of chest pain, and to assess whether a multifactorial model including these factors can distinguish patients with NCCP from patients with cardiac chest pain (CCP). A total of 240 patients with chest pain answered questionnaires concerning anxiety sensitivity (Anxiety Sensitivity Index-3), somatic amplification (Somatosensory Amplification Scale), illness perceptions (Illness Perception Questionnaire-Brief, health concerns, and heart disease conviction), and pain characteristics (intensity, disability, and frequency) before the evaluation of chest pain causation. They were classified as having NCCP or CCP by cardiac angiography. Partial correlation analyses and binary logistic regression analyses were performed. Seventy percent of patients with chest pain were classified as having NCCP. A range of cognitive-perceptual factors were associated with the experience of chest pain. On multivariate analyses, the only psychological factor found to differentiate NCCP from CCP was elevated somatic amplification (relative risk = 1.06, 95% confidence interval = 1.00-1.13). The current DSM-5 proposal with regard to somatic symptom disorder recommends using psychological factors as diagnostic criteria for medically unexplained symptoms while placing less emphasis on the criterion of lack of somatic causation. In this study, an association between pain characteristics and cognitive-perceptual factors was found both for patients with NCCP and for patients with CCP. We found no evidence for a specific profile of psychological characteristics distinguishing patients with NCCP from patients with CCP, except for somatic amplification.