The present study tested the hypothesis that social problem solving (SPS) served to mediate the relationship between preceived stress and noncardiac chest pain (NCCP). Adults undergoing stress myocardial perfusion imaging (MPI) to determine the presence of underlying cardiovascular disease related to the experience of chest pain were recruited prior to stress testing to complete a series of self-report inventories. MPI results were used to identify individuals with NCCP (N = 166; 91 men, 75 women; mean age = 53.92 years, SD = 11.98). Measures included perceived stress, SPS, and chest pain frequency and intensity. In direct tests of the mediational effects of SPS, it was found that two problem-solving dimensions, negative problem orientation and rational problem solving, each served as significant mediators of the effects of stress on both NCCP intensity and frequency. These results support a mediational analysis of NCCP that includes stress and SPS. As such, it identifies SPS as a potentially important clinical target to consider when developing future psychosocial-based therapy protocols for treating individuals with NCCP.