Review: some evidence suggests that cognitive behaviour therapy may reduce chest pain in the short term in patients with non-specific chest pain and normal coronary anatomy.

Are psychological treatments effective for patients with non-specific chest pain and normal coronary anatomy?METHODSData sources: Cochrane Review Group Specialised registers (November 2002); Cochrane Library (Issue 3, 2002); Medline (1966-2002); CINAHL (1982-2002); EMBASE/Excerpta Medica (1980-2002); PsycLIT (1887-2002); Biological Abstracts BIOSIS (1980-2002); reference lists of relevant studies and reviews; abstracts from cardiology, psychiatry, and psychiatry conferences; and personal communication with authors.Study selection and assessment: randomised controlled trials (RCTs) that compared psychological interventions (cognitive behaviour therapy [CBT], relaxation therapy, hyperventilation control, or other psychotherapy, talking, or counselling therapy) with standard care, an attention placebo, or no intervention in patients with non-specific chest pain, atypical chest pain, or syndrome X and normal coronary anatomy. Patients receiving drug treatment for psychiatric disorders were excluded. Individual study quality was assessed based on randomisation, allocation concealment, blinding, and loss to follow up.Outcomes: significant reduction in chest pain (pain intensity measured by categorical or visual analogue scales; or mean difference in pain scores or frequency of exacerbation).MAIN RESULTS8 RCTs (403 outpatients) met the selection criteria. Interventions assessed were CBT, brief nurse intervention, relaxation training, and breathing retraining. Follow up ranged from 3-36 months, and 5 trials had >80% follow up.Meta-analysis using a fixed effects model showed that more patients who received psychological interventions (specifically CBT) had reductions in chest pain than those in the control group at 3 months and at 3-9 months (table). Similar results were found using a random effects model. Meta-analysis of 2 trials (n = 81) also showed that patients who received psychological interventions had a greater increase in chest pain free days at