Factors associated with pain level in non-cardiac chest pain patients with comorbid panic disorder

Guillaume Foldes-Busque, Stéphanie Hamel, Geneviève Belleville, Richard Fleet, Julien Poitras, Jean-Marc Chauny, Alain Vadeboncoeur, Kim L Lavoie, André Marchand, Guillaume Foldes-Busque, Stéphanie Hamel, Geneviève Belleville, Richard Fleet, Julien Poitras, Jean-Marc Chauny, Alain Vadeboncoeur, Kim L Lavoie, André Marchand

Abstract

Background: Panic disorder (PD) is highly prevalent in patients with non-cardiac chest pain (NCCP). This study aims to explore the role of psychological factors (PD intensity, anxiety sensitivity, heart-related fear, attention and avoidance) common to NCCP and PD in predicting chest pain levels in patients with both conditions.

Methods: This association was investigated in emergency department patients with NCCP and PD receiving either evidence-based treatment of PD or treatment as usual. Patients were assessed at baseline and 14 weeks later for post-treatment.

Results: Only heart-focused fear and attention for cardiac sensations independently explained a significant portion of the variance in baseline pain (n = 66). At 3 months follow-up (n = 53), changes in heart-related fear was the only factor independently associated with changes in chest pain intensity. Even in patients with PD, fear specific to cardiac sensations seems to play a central role in determining NCCP intensity.

Conclusion: These results suggest that the efficacy of intervention for patients with PD and comorbid NCCP could be improved by targeting heart-related fear and attention.

Trial registration: NCT00736346.

Keywords: Anxiety sensitivity; Cardiac anxiety; Chest pain; Heart-focused anxiety; Non-cardiac chest pain; Panic disorder.

Figures

Fig. 1
Fig. 1
Flowchart of recruitment

References

    1. Eslick GD, Talley NJ. Non-cardiac chest pain: predictors of health care seeking, the types of health care professional consulted, work absenteeism and interruption of daily activities. Aliment Pharmacol Ther. 2004;20(8):909–15. doi: 10.1111/j.1365-2036.2004.02175.x.
    1. Mayou R. Chest pain, palpitations and panic. J Psychosom Res. 1998;44(1):53–70. doi: 10.1016/S0022-3999(97)00209-2.
    1. Potts SG, Bass CM. Psychosocial outcome and use of medical resources in patients with chest pain and normal or near-normal coronary arteries: a long-term follow-up study. Q J Med. 1993;86(9):583–93.
    1. Cheung TK, Hou X, Lam KF, Chen J, Wong WM, Cha H, et al. Quality of life and psychological impact in patients with noncardiac chest pain. J Clin Gastroenterol. 2009;43(1):13–8. doi: 10.1097/MCG.0b013e3181514725.
    1. Fagring AJ, Gaston-Johansson F, Kjellgren KI, Welin C. Unexplained chest pain in relation to psychosocial factors and health-related quality of life in men and women. Eur J Cardiovasc Nurs. 2007;6(4):329–36. doi: 10.1016/j.ejcnurse.2007.05.001.
    1. Fagring AJ, Kjellgren KI, Rosengren A, Lissner L, Manhem K, Welin C. Depression, anxiety, stress, social interaction and health-related quality of life in men and women with unexplained chest pain. BMC Public Health. 2008;8:165. doi: 10.1186/1471-2458-8-165.
    1. Eslick GD, Talley NJ. Natural history and predictors of outcome for non-cardiac chest pain: a prospective 4-year cohort study. Neurogastroenterol Motil. 2008;20(9):989–97. doi: 10.1111/j.1365-2982.2008.01133.x.
    1. Carter C, Maddock R, Amsterdam E, McCormick S, Waters C, Billett J. Panic disorder and chest pain in the coronary care unit. Psychosomatics. 1992;33(3):302–9. doi: 10.1016/S0033-3182(92)71969-0.
    1. Kessler RC, Chiu WT, Jin R, Ruscio AM, Shear K, Walters EE. The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2006;63:415–24. doi: 10.1001/archpsyc.63.4.415.
    1. Foldes-Busque G, Marchand A, Chauny JM, Poitras J, Diodati J, Denis I, et al. Unexplained chest pain in the ED: could it be panic? Am J Emerg Med. 2011;29(7):743–51. doi: 10.1016/j.ajem.2010.02.021.
    1. Dammen T, Ekeberg O, Arnesen H, Friis S. Health-related quality of life in non-cardiac chest pain patients with and without panic disorder. Int J Psychiatry Med. 2008;38(3):271–86. doi: 10.2190/PM.38.3.d.
    1. Bull Bringager C, Arnesen H, Friis S, Husebye T, Dammen T. A long-term follow-up study of chest pain patients: effect of panic disorder on mortality, morbidity, and quality of life. Cardiology. 2008;110(1):8–14. doi: 10.1159/000109400.
    1. Fleet RP, Lavoie KL, Martel JP, Dupuis G, Marchand A, Beitman BD. Two-year follow-up status of emergency department patients with chest pain: Was it panic disorder? CJEM. 2003;5(4):247–54. doi: 10.1017/S1481803500008447.
    1. Marchand A, Belleville G, Fleet R, Dupuis G, Bacon SL, Poitras J, et al. Treatment of panic in chest pain patients from emergency departments: efficacy of different interventions focusing on panic management. Gen Hosp Psychiatry. 2012;34(6):671–80. doi: 10.1016/j.genhosppsych.2012.06.011.
    1. Eifert GH, Zvolensky MJ, Lejuez CW. Heart-focused anxiety and chest pain: a conceptual and clinical review. Clin Psychol Sci Pract. 2000;7(4):403–17. doi: 10.1093/clipsy.7.4.403.
    1. White KS, McDonnell CJ, Gervino EV. Alexithymia and anxiety sensitivity in patients with non-cardiac chest pain. J Behav Ther Exp Psychiatry. 2011;42(4):432–9. doi: 10.1016/j.jbtep.2011.04.001.
    1. Deacon B, Abramowitz J. Anxiety sensitivity and its dimensions across the anxiety disorders. J Anxiety Disord. 2006;20(7):837–57. doi: 10.1016/j.janxdis.2006.01.003.
    1. Colloca L, Benedetti F. Nocebo hyperalgesia: how anxiety is turned into pain. Curr Opin Anaesthesiol. 2007;20(5):435–9. doi: 10.1097/ACO.0b013e3282b972fb.
    1. Keogh E, Cochrane M. Anxiety sensitivity, cognitive biases, and the experience of pain. J Pain. 2002;3(4):320–9. doi: 10.1054/jpai.2002.125182.
    1. Woud ML, Zhang XC, Becker ES, McNally RJ, Margraf J. Don’t panic: interpretation bias is predictive of new onsets of panic disorder. J Anxiety Disord. 2014;28(1):83–7. doi: 10.1016/j.janxdis.2013.11.008.
    1. De Cort K, Griez E, Buchler M, Schruers K. The role of “interoceptive” fear conditioning in the development of panic disorder. Behav Ther. 2012;43(1):203–15. doi: 10.1016/j.beth.2011.06.005.
    1. White KS. Assessment and treatment of psychological causes of chest pain. Med Clin N Am. 2010;94(2):291–318. doi: 10.1016/j.mcna.2010.01.005.
    1. White KS, Craft JM, Gervino EV. Anxiety and hypervigilance to cardiopulmonary sensations in non-cardiac chest pain patients with and without psychiatric disorders. Behav Res Ther. 2010;48(5):394–401. doi: 10.1016/j.brat.2010.01.001.
    1. Eifert GH. Cardiophobia: a paradigmatic behavioural model of heart-focused anxiety and non-anginal chest pain. Behav Res Ther. 1992;30(4):329–45. doi: 10.1016/0005-7967(92)90045-I.
    1. Aikens JE, Zvolensky MJ, Eifert GH. Differential fear of cardiopulmonary sensations in emergency room noncardiac chest pain patients. J Behav Med. 2001;24(2):155–67. doi: 10.1023/A:1010710614626.
    1. Asmundson G, Katz J. Understanding the co-occurrence of anxiety disorders and chronic pain: state-of-the-art. Depress Anxiety. 2009;26(10):888–901. doi: 10.1002/da.20600.
    1. Asmundson GJ, Norton PJ, Norton GR. Beyond pain: the role of fear and avoidance in chronicity. Clin Psychol Rev. 1999;19(1):97–119. doi: 10.1016/S0272-7358(98)00034-8.
    1. DiNardo PA, Brown TA, Barlow DH. Anxiety disorders interview schedule for DSM-IV (ADIS-IV): lifetime version (ADIS-IV-L) San Antonio: Psychological Corporation; 1994.
    1. Bandelow B. Assessing the efficacy of treatments for panic disorder and agoraphobia. II. The panic and agoraphobia scale. Int Clin Psychopharmacol. 1995;10(2):73–81. doi: 10.1097/00004850-199506000-00003.
    1. Bandelow B. Panic and Agoraphobia Scale (PAS) Seattle: Hogrefe & Huber Publishers; 1999.
    1. Reiss S, Peterson RA, Gursky DM, McNally RJ. Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behav Res Ther. 1986;24(1):1–8. doi: 10.1016/0005-7967(86)90143-9.
    1. Peterson RA, Reiss S. Anxiety sensitivity index revised test manual. Worthington: IDS Publishing Corporation; 1993.
    1. Melzack R. The short-form McGill pain questionnaire. Pain. 1987;30(2):191–7. doi: 10.1016/0304-3959(87)91074-8.
    1. Graham C, Bond SS, Gerkovich MM, Cook MR. Use of the McGill pain questionnaire in the assessment of cancer pain: replicability and consistency. Pain. 1980;8(3):377–87. doi: 10.1016/0304-3959(80)90081-0.
    1. Eifert GH, Thompson RN, Zvolensky MJ, Edwards K, Frazer NL, Haddad JW, et al. The cardiac anxiety questionnaire: development and preliminary validity. Behav Res Ther. 2000;38(10):1039–53. doi: 10.1016/S0005-7967(99)00132-1.
    1. van Beek MH, Voshaar RC, van Deelen FM, van Balkom AJ, Pop G, Speckens AE. The cardiac anxiety questionnaire: cross-validation among cardiac inpatients. Int J Psychiatry Med. 2012;43(4):349–64. doi: 10.2190/PM.43.4.e.
    1. Keogh E, Hamid R, Hamid S, Ellery D. Investigating the effect of anxiety sensitivity, gender and negative interpretative bias on the perception of chest pain. Pain. 2004;111(1-2):209–17. doi: 10.1016/j.pain.2004.06.017.
    1. Craske MG, Barlow DH. Panic disorder and agoraphobia. In: Barlow DH, editor. Clinical handbook of psychological disorders: A step-by-step treatment manual. 3. New York: The Guilford Press; 2001.
    1. Asmundson GJG, Abrams MP, Collimore KC. Pain and anxiety disorders. In: Zvolensky MJ, Smits JAJ, editors. Health behaviors and physical illness in anxiety and its disorders: Contemporary theory and research. New York: Springer; 2008. pp. 207–35.
    1. Craske M, Waters AM. Panic disorder, phobias, and generalized anxiety disorder. Annu Rev Clin Psychol. 2005;1:197–225. doi: 10.1146/annurev.clinpsy.1.102803.143857.
    1. Belleville G, Foldes-Busque G, Marchand A. Characteristics of panic disorder patients consulting an emergency department with noncardiac chest pain. Prim Psychiatry. 2010;17:35–42.
    1. Fleet RP, Marchand A, Dupuis G, Kaczorowski J, Beitman BD. Comparing emergency department and psychiatric setting patients with panic disorder. Psychosomatics. 1998;39(6):512–8. doi: 10.1016/S0033-3182(98)71283-6.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever