Abstract
ABSTRACTBackground: Non-cardiac chest pain (NCCP) is associated with psychological distress, work absenteeism, impaired functioning and reduced quality of life. This study explores how a novel biopsychosocial, stepped-care treatment for NCCP works, and explores outcomes at each step and process variables. Methods: Patients with persistent NCCP were referred to a new biopsychosocial, multidisciplinary clinic for chest pain (CP). There were three possible ‘steps’ of treatment: (1) biopsychosocial assessment (BA) only, (2) BA plus low-intensity cognitive behaviour therapy (CBT) and (3) BA plus high-intensity CBT. Outcome measures assessed chest pain (frequency and interference), anxiety (GAD7), depression (Patient Health Questionnaire-9 (PHQ-9)), somatic symptoms (PHQ-15) and illness perceptions (Brief Illness Perception Questionnaire) at baseline, 3 and 6 months post-assessment. Participants gave feedback about treatment once completed, which was analysed using content analysis. Results: Significant improvements were found on all outcome measures at 3 months and 6 months compared to baseline. Benefits were found in all treatment steps and occurred regardless of baseline distress, chest pain or demographic characteristics. The strongest predictor of improvement in chest pain at 6 months was a positive change in illness perceptions at 3 months. Patients reported how treatment helped by increasing their understanding of chest pain, reducing concern and improving their sense of control. Conclusions: A biopsychosocial, stepped-care intervention appears to be effective, efficient and acceptable for a variety of patients with NCCP. Changes in beliefs about chest pain were the main predictors of improvement (reduced chest pain interference and frequency) at 6 months follow up.
Highlights
Non-cardiac chest pain (NCCP) is common, with a population prevalence of 16–20% (Hotopf, Mayou, Wadsworth, & Wessely, 1999; Nimnuan, Hotopf, & Wessely, 2001)
Consecutive NCCP patients were referred from a RACPC in an inner London teaching hospital to the Multidisciplinary Chest Pain Clinic (MDCPC) from December 2011 to December 2012
Age Gender (% male) Ethnicity (% white) SES (% educated more than 16 years) SES (% with manual occupation) Chest pain interference-baseline Panic disorder criteria met? Health anxiety disorder met? Other mental health disorder diagnosed Other physical health condition Other ‘persistent physical symptoms’ disorder diagnosed Work and Social Adjustment Scale (WSAS) total score Prescribed medication No treatment sessions attended
Summary
Non-cardiac chest pain (NCCP) is common, with a population prevalence of 16–20% (Hotopf, Mayou, Wadsworth, & Wessely, 1999; Nimnuan, Hotopf, & Wessely, 2001). It accounts for approximately three quarters of patients attending Rapid Access Chest. NCCP patients report persistent pain, distress and impairment (Chambers et al, 2013). Non-cardiac chest pain (NCCP) is associated with psychological distress, work absenteeism, impaired functioning and reduced quality of life. Patients reported how treatment helped by increasing their understanding of chest pain, reducing concern and improving their sense of control. Changes in beliefs about chest pain were the main predictors of improvement (reduced chest pain interference and frequency) at 6 months follow up
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