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

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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

Related collections

Most cited references 39

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The short-form McGill Pain Questionnaire.

Ronald Melzack (1987)

A short form of the McGill Pain Questionnaire (SF-MPQ) has been developed. The main component of the SF-MPQ consists of 15 descriptors (11 sensory; 4 affective) which are rated on an intensity scale as 0 = none, 1 = mild, 2 = moderate or 3 = severe. Three pain scores are derived from the sum of the intensity rank values of the words chosen for sensory, affective and total descriptors. The SF-MPQ also includes the Present Pain Intensity (PPI) index of the standard MPQ and a visual analogue scale (VAS). The SF-MPQ scores obtained from patients in post-surgical and obstetrical wards and physiotherapy and dental departments were compared to the scores obtained with the standard MPQ. The correlations were consistently high and significant. The SF-MPQ was also shown to be sufficiently sensitive to demonstrate differences due to treatment at statistical levels comparable to those obtained with the standard form. The SF-MPQ shows promise as a useful tool in situations in which the standard MPQ takes too long to administer, yet qualitative information is desired and the PPI and VAS are inadequate.

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Understanding the co-occurrence of anxiety disorders and chronic pain: state-of-the-art.

Gordon Asmundson, Joel Katz (2009)

The purpose of this article is to describe the current state-of-the-art regarding the co-occurrence of the anxiety disorders and chronic pain. First, we describe the core characteristics of chronic pain and its co-occurrence with the anxiety disorders. Second, we review data on the prevalence of co-occurrence. Third, we describe the mutual maintenance and shared vulnerability models, both of which have been offered to explain the co-occurrence of posttraumatic stress disorder (PTSD) and chronic pain and may have applicability to various other anxiety disorders. Fourth, we provide an integrative review of available research addressing the postulates of these models specific to the mechanisms of anxiety sensitivity, selective attention to threat, and reduced threshold for alarm. We conclude with general recommendations for improving assessment and treatment of patients who present with an anxiety disorder accompanied by clinically significant pain. Given that most of the available evidence has come from studies of PTSD and chronic pain, we provide a detailed agenda for future investigation of the co-occurrence of chronic pain and other anxiety disorders.

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The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication.

Ronald C Kessler, Wai Tat Chiu, Robert Jin … (2006)

Only limited information exists about the epidemiology of DSM-IV panic attacks (PAs) and panic disorder (PD). To present nationally representative data about the epidemiology of PAs and PD with or without agoraphobia (AG) on the basis of the US National Comorbidity Survey Replication findings. Nationally representative face-to-face household survey conducted using the fully structured World Health Organization Composite International Diagnostic Interview. English-speaking respondents (N=9282) 18 years or older. Respondents who met DSM-IV lifetime criteria for PAs and PD with and without AG. Lifetime prevalence estimates are 22.7% for isolated panic without AG (PA only), 0.8% for PA with AG without PD (PA-AG), 3.7% for PD without AG (PD only), and 1.1% for PD with AG (PD-AG). Persistence, lifetime number of attacks, and number of years with attacks increase monotonically across these 4 subgroups. All 4 subgroups are significantly comorbid with other lifetime DSM-IV disorders, with the highest odds for PD-AG and the lowest for PA only. Scores on the Panic Disorder Severity Scale are also highest for PD-AG (86.3% moderate or severe) and lowest for PA only (6.7% moderate or severe). Agoraphobia is associated with substantial severity, impairment, and comorbidity. Lifetime treatment is high (from 96.1% for PD-AG to 61.1% for PA only), but 12-month treatment meeting published treatment guidelines is low (from 54.9% for PD-AG to 18.2% for PA only). Although the major societal burden of panic is caused by PD and PA-AG, isolated PAs also have high prevalence and meaningful role impairment.

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Author and article information

Contributors

Guillaume Foldes-Busque: 1-418-656-2131 ext. 2592 , guillaume.foldes-busque@psy.ulaval.ca

Stéphanie Hamel: stephanie.hamel.3@ulaval.ca

Geneviève Belleville: genevieve.belleville@psy.ulaval.ca

Richard Fleet: rfleet@videotron.ca

Julien Poitras: julien.poitras@fmed.ulaval.ca

Jean-Marc Chauny: chaunyj@videotron.ca

Alain Vadeboncoeur: alain.vadeboncoeur@gmail.com

Kim L. Lavoie: lavoie.kim@uqam.ca

André Marchand: marchand.andre@uqam.ca

Journal

Journal ID (nlm-ta): Biopsychosoc Med

Journal ID (iso-abbrev): Biopsychosoc Med

Title: Biopsychosocial Medicine

Publisher: BioMed Central (London )

ISSN (Electronic): 1751-0759

Publication date (Electronic): 18 October 2016

Publication date PMC-release: 18 October 2016

Publication date Collection: 2016

Volume: 10

Electronic Location Identifier: 30

Affiliations

[1 ]School of Psychology, Université Laval, 2325, rue des Bibliothèques, Bureau 1116, Québec, G1V 0A6 Canada

[2 ]Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, 143 rue Wolfe, Lévis, Québec G6V 3Z1 Canada

[3 ]Research Chair in Emergency Medicine of Laval University, University Affiliated Hospital Hôtel-Dieu de Lévis, 143 rue Wolfe, Lévis, Québec G6V 3Z1 Canada

[4 ]Department of Family and Emergency Medicine, Université Laval, 1050 Avenue de la Médecine, Bureau 4617, Québec, G1V 0A6 Canada

[5 ]Research Centre, Montreal Sacré-Coeur Hospital, 5400 Boulevard Gouin Ouest, local K-3000, Montréal, Québec H4J 1C5 Canada

[6 ]Research Centre, Montreal Heart Institute, 5000 rue Bélanger, Montréal, Québec H1T 1C8 Canada

[7 ]Psychology Department, Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, Montréal, Québec H3C 3P8 Canada

[8 ]Fernand-Séguin Research Centre, Louis-Hippolyte Lafontaine Hospital, 7331 rue Hochelaga, Montréal, Québec H1N 3V2 Canada

Article

Publisher ID: 81

DOI: 10.1186/s13030-016-0081-5

PMC ID: 5070074

SO-VID: f43a7b30-3414-48e9-a1d5-f210df5b6dd2

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 2 August 2016

Date accepted : 12 October 2016

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000034, Institute of Neurosciences, Mental Health and Addiction;

Award ID: 153245

Award Recipient : André Marchand

Funded by: FundRef http://dx.doi.org/10.13039/501100000156, Fonds de Recherche du Québec - Santé;

Award ID: 28882

Award Recipient : Guillaume Foldes-Busque

Funded by: FundRef http://dx.doi.org/10.13039/100008240, Fonds de Recherche du Québec-Société et Culture;

Award ID: 29533

Award Recipient : Stéphanie Hamel

Custom metadata

ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: anxiety sensitivity,cardiac anxiety,chest pain,non-cardiac chest pain,heart-focused anxiety,panic disorder

Data availability:

ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: anxiety sensitivity, cardiac anxiety, chest pain, non-cardiac chest pain, heart-focused anxiety, panic disorder

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

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Abstract

Background

Methods

Results

Conclusion

Trial registration

Related collections

Journal of Behavioral Addictions

Most cited references 39

The short-form McGill Pain Questionnaire.

Understanding the co-occurrence of anxiety disorders and chronic pain: state-of-the-art.

The epidemiology of panic attacks, panic disorder, and agoraphobia in the National Comorbidity Survey Replication.

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