Mindfulness-based intervention in patients with persistent pain in chest (MIPIC) of non-cardiac cause: a feasibility randomised control study

Tarun Kumar Mittal, Emma Evans, Alison Pottle, Costas Lambropoulos, Charlotte Morris, Christina Surawy, Antony Chuter, Felicia Cox, Ranil de Silva, Mark Mason, Winston Banya, Diviash Thakrar, Peter Tyrer, Tarun Kumar Mittal, Emma Evans, Alison Pottle, Costas Lambropoulos, Charlotte Morris, Christina Surawy, Antony Chuter, Felicia Cox, Ranil de Silva, Mark Mason, Winston Banya, Diviash Thakrar, Peter Tyrer

Abstract

Objective: The study evaluated the feasibility of mindfulness-based cognitive therapy (MBCT) in patients with non-cardiac chest pain by assessing their willingness to participate and adhere to the programme, and for these data to help further refine the content of MBCT for chest pain.

Patients and methods: This prospective 2:1 randomised controlled trial compared the intervention of adapted MBCT as an addition to usual care with just usual care in controls. Among 573 patients who attended the rapid access chest pain clinic over the previous 12 months and were not diagnosed with a cardiac cause but had persistent chest pain were invited. The intervention was a 2-hour, weekly, online guided 8-week MBCT course. Compliance with attendance and the home practice was recorded. Enrolled patients completed the Seattle angina questionnaire (SAQ), Hospital Anxiety and Depression Scale, Cardiac Anxiety Questionnaire, Five-Facet Mindfulness Questionnaire, and Euro Quality of Life-5 Dimensions-5 Level at baseline assessment and after 8-week period.

Results: Persistent chest pain was reported by 114 patients. Of these, 33 (29%) patients with a mean age of 54.2 (±12.2) years and 68% women, consented to the study. Baseline questionnaires revealed mild physical limitation (mean SAQ, 76.8±25), high levels of anxiety (76%) and depression (53%), modest cardiac anxiety (CAQ,1.78±0.61) and mindfulness score (FFMQ, 45.5±7.3). Six patients subsequently withdrew due to bereavement, caring responsibilities and ill health. Of the remaining 27 participants, 18 in the intervention arm attended an average of 5 sessions with 61% attending ≥6 sessions. Although not statistically powered, the study revealed a significant reduction in general anxiety, improved mindfulness and a trend towards improvement in SAQ scores in the intervention arm.

Conclusion: One-third of patients with persistent non-cardiac chest pain were willing to participate in mindfulness-based therapy. An improvement in anxiety and mindfulness was detected in this feasibility study. A larger trial is required to demonstrate improvement in chest pain symptoms.

Trial registration: ClinicalTrials.gov NCT04151121.

Keywords: ANXIETY; Chest Pain; DEPRESSION; Delivery of Health Care.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
CONSORT diagram of patient recruitment. CABG, coronary artery bypass surgery; CONSORT, Consolidated Standards of Reporting Trials; PCI, percutaneous coronary intervention; RACPC, rapid access chest pain clinic.

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