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

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 14weeks 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 3months 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