New study examines non-specific chest pain
Last Updated: Tuesday, February 09, 2010, 00:00
  

Washington: A new German study has examined the course and treatment of "non-specific" (unexplained) chest pain.



The study has appeared in the February 8 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

The research found that fewer than 50percent of those experiencing this unexplained pain can get relief from symptoms following standard medical care, while one-tenth of those with persistent chest pain undergo potentially unnecessary diagnostic testing.



Over 50percent of patients with chest pain are classified as not having an underlying heart condition. Some have another well-established medical condition, such as upper respiratory tract infection, but for many no pathophysiologic cause can be found.



According to the authors, such non-specific chest pain "is a frequent phenomenon in primary care…However, knowledge about the course and outcome of this condition is sparse."



Julia Anna Glombiewski of Philipps-University of Marburg, Germany, and colleagues studied 807 patients (average age 57.6 years) 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 six weeks and then six months after the initial consultation.

Among the 755 study patients who provided data at the six-month follow-up, 419 (55.5percent) still had chest pain. Also, 45 (10.7percent) of those were categorized as using health care in an inappropriate manner, defined as two or more visits to a cardiologist or three or more cardiac diagnostic evaluations - including angiograms and electrocardiograms - within six months. This compared with 24 (7.1percent) of 336 patients with remitted chest pain.



Only six patients, less than 2 percent, were referred to mental health specialists for ongoing chest pain.



The authors write: "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.



"Patients with psychologically caused non-specific chest pain showed more problematic health care–seeking behavior but were rarely referred to mental health professionals. Patients, general practitioners or both seem to be hesitant to involve psychological interventions."



The authors conclude: "Future research should investigate the development of effective interventions for non-specific chest pain and their implementation within health care systems."



ANI


First Published: Tuesday, February 09, 2010, 00:00



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