April 20, 2006 - Severe chest pain is a serious symptom of that should never be ignored, but not all chest pain has a cardiac cause.
In up to almost a third of cases when heart disease is suspected, no obvious coronary artery disease of the heart can be found to explain frequent chest pain. Noncardiac chest pain is poorly understood and difficult to treat, but new research shows that an unconventional therapy can help patients feel better.
In the small study, patients with unexplained chest pain improved significantly when treated with hypnosis. All of the patients had been evaluated for their chest pain with coronary angiograms and were found to have no evidence of coronary artery disease.
Fifteen patients received 12 sessions of hypnotherapy over 17 weeks, while 13 others got supportive therapy with no hypnosis. A total of 80% of the hypnosis patients reported significant pain relief following treatment, compared with 23% of the supportive-care patients.
The hypnotherapy patients had the same number of chest pain episodes as they did before treatment, but they reported being bothered less by the pain and having an improved overall sense of well-being. They also took less medication to control their pain.
The findings appear today in an online issue of the journal Gut.
"Hypnotherapy didn't abolish the pain, it just reduced it and made it less of an issue in these people's daily lives," researcher Peter J. Whorwell, MD, tells WebMD.
Few Treatment Options
Whorwell and colleagues from Wythenshawe Hospital in the U.K. were the first to use hypnosis to treat another poorly understood and hard-to-treat condition -- irritable bowel syndrome -- more than two decades ago.
The researchers decided to try the therapy for noncardiac chest pain because patients with the condition have few treatment options.
Chest pain symptoms among patients with disease often improve when they are treated with acid-reducing medications (such as Prevacid, Prilosec, Protonix, and Nexium), but no obvious cause can be found for most patients with noncardiac chest pain.
"These patients often fall through the cracks in terms of treatment," he says. "Once a cardiac cause has been ruled out the cardiologist loses interest. Patients are told there is nothing to worry about, but the chest pain can be severely incapacitating."
Are Heart Symptoms Missed in Women?
But cardiologist Nieca Goldberg, MD, warns that ruling out a cardiac cause, especially among women, is easier said than done.
Women are more likely than men to have noncardiac chest pain. But they are also more likely to have-related chest pain that is not picked up by conventional diagnostic tests.
A coronary angiogram can miss a potentially life-threatening disorder called microvascular disease. In that disorder smaller arteries that supply blood to the heart may have plaque deposits that are spread out rather than form a major blockage.
As many as 3 million American women may be at high risk for heart attacks without knowing it because they have microvascular disease, a study funded by the National Institutes of Health revealed last January.
"Before we can say for sure that someone's chest discomfort is noncardiac in nature, we need to do a thorough investigation," Goldberg says.
She is chief of women's cardiac care at Manhattan's Lenox Hill Hospital and the author of the book Women's Healthy Heart Program - Lifesaving Strategies for Preventing and Healing Heart Disease. She is also a spokeswoman for the American Heart Association.
Goldberg stresses that because heart disease is often missed in women, pursuing a diagnosis is especially important.
"The danger in a study like this one is that women with chest pain may give up looking for a cause too quickly, and focus, instead, only on making the pain go away," she says.