Category: Health Psychology / Behavioral Medicine - Adult
Chest pain can be frightening given its association with myocardial infarction, but up to 75% of individuals seeking urgent medical care due to chest pain are left without an organic explanation for their symptoms (Pope et al., 1998; Kroenke & Mangelsdorff, 1989). The experience of recurrent angina-like pain in the absence of identifiable organic etiology is known as non-cardiac chest pain (NCCP; Eslick et al., 2002). Researchers have proposed that physiological mechanisms related to gastroesophageal reflux disease (GERD) contribute to NCCP. GERD is a condition characterized by bothersome symptoms, such as heartburn, that arise due to the reflux of stomach contents (Vakil et al., 2006). While studies have found that as many as 50% of patients presenting with NCCP exhibit abnormal oesophageal acid exposure (Fass et al., 1998), general prevalence estimates of GERD among patients diagnosed with NCCP range from 21-60% (Liuzzo & Ambrose, 2005). Although GERD-related physiological mechanisms may contribute to chest pain in some NCCP patients, for others the underlying causes remain idiopathic or unknown. Biopsychosocial models of NCCP posit the role of psychological factors related to anxiety in the development and maintenance of the condition (White & Raffa, 2004). Guided by this framework, researchers have found anxiety sensitivity and body vigilance to be empirically related to NCCP (White, McDonnell, & Gervino, 2011; White, Craft, & Gervino, 2010), yet few studies have examined these psychological risk factors in NCCP patients tested for abnormal oesophageal acid exposure. The aim of this study was to examine whether these psychological risk factors are predictive of NCCP patients whose symptoms remain unexplained by GERD-related pathophysiological mechanisms.
Patients included 64 adults diagnosed with NCCP who were tested via 24-hour pH monitoring for GERD-related oesophageal acid exposure. The sample consisted predominately of White (90%) women (70%) and men (30%). Mean age was 52. Most patients (79%) reported at least weekly episodes of chest pain, and 71% described their chest pain as being of at least moderate intensity. Although chest pain severity did not differ across the two groups (p = 0.56), NCCP patients with no signs of GERD (n = 26) reported more life interference due to their chest pain compared to those with GERD-related symptoms (n = 38; p < 0.05). A Logistic regression model using anxiety sensitivity and body vigilance to predict whether NCCP patients exhibit signs of GERD was statistically significant, χ2(5) = 11.2, p < .05. The model explained 22% of the variance in GERD-related symptoms and correctly classified 67% of cases. Higher levels of body vigilance were associated with an increased likelihood of having NCCP without GERD-related pathophysiology. Anxiety sensitivity did not significantly predict whether patients’ symptoms were GERD-related. These results suggest increased body vigilance may be a psychological risk factor uniquely predictive of NCCP patients whose symptoms do not appear to be explained by physiological mechanisms associated with GERD. Such findings provide further insight into etiology and maintenance of NCCP.