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Children With Non-Cardiac Chest Pain May Have Anxiety

Update Date: Nov 17, 2012 05:40 AM EST

A study by researchers from the University of Georgia has found that children who complain of chest pain could have psychological factors affecting them.

The university psychologists have discovered that children who are diagnosed with a noncardiac chest pain have higher levels of anxiety and depression than those who are diagnosed with innocent heart murmurs-the noise of normal turbulent blood flow in a structurally normal heart, Medical Xpress reported.

"The fact that these psychological symptoms are higher in noncardiac chest pain patients suggests the psychological symptoms may be playing a role in the presentation of chest pain," said Jennifer Lee, a doctoral candidate in the UGA Franklin College of Arts and Sciences and the study's lead author.

The study has revealed a significant increase in the number of patients with anxiety and depression who are later diagnosed with noncardiac chest pain when compared to patients diagnosed with innocent heart murmurs.

However, Lee said that it still cannot be established if the pain caused anxiety or if it was the other way around in the sample group.

"The higher levels weren't so high as to cause a clinical diagnosis on their own, but when you contrast the two groups, there were statistically significant differences," said study co-author Ronald Blount, a psychology professor in Franklin College.

For the study, the researchers observed 129 patients aged between 8 and 18 and the survey was completed by the patients before their diagnosis, while they awaited their results.

"We are highlighting that psychology has a part in these symptoms," Blount said, "and screening for psychological, as well as medical factors, is one implication we foresee coming from this investigation."

While among adults, chest pain is often linked to cardiac problems, only less than 2 percent of children who complain of chest pain are diagnosed with a cardiac problem.

"We know up front that 99 percent of these patients will not have a heart complication at all. The trick is, it is not zero, and I cannot miss the one patient with heart disease because the consequences could be catastrophic," said Dr. Robert Campbell, chief of the Sibley Heart Center and division director of the department of pediatrics at the Emory University School of Medicine. The Sibley Heart Center at Children's Healthcare of Atlanta is one of the largest pediatric heart centers in the world, seeing an average of 2,500 new patients with acute chest pain each year.

Other revelations of the study were that noncardiac chest pain patients apparently are more likely to have difficulty participating in everyday activities than others. They were found to be less active in school (extra-curricular activities) and also spent less time there.

"These kids also report greater levels of physical symptoms with unclear causes, like joint pain, stomach aches, head aches," Lee said. "These symptoms are believed to be psychological manifestations of stress. Sometimes your brain doesn't tell you that you are stressed out, but your body does, so you will experience symptoms like these."

Also, children with noncardiac chest pain reported higher levels of anxiety sensitivity, a fear of experiencing physical symptoms and additionally fearing that those symptoms are related to a catastrophic health issue, the report said.

"Psychological functioning is heavily related to pain," Blount said. "Pain is a sensory experience, but your attention to one thing or another and your emotions can impact your experience of pain. And how debilitating the pain is for you can be determined by psychological and social factors. That is what we were interested in looking at." Previous studies have shown reducing emotional symptoms can lead to better coping ability with pain, Lee said.

"A goal with these patients would be to create a clearer, more comprehensive picture of what is going on and determine a better way to help these kids and adolescents."

According to Campbell, the findings of this study help him understand and serve those patients who are not diagnosed with anything but unexplained chest pain.

"Most importantly what we've learned is that after a physical evaluation of the patient, we take the time to sit down with the family and find out what they are most worried about so we can address their psychological issues," Campbell said. "We've learned to pay attention and to be confident and reassuring. I need to make it clear to my patients and their parents that I'm not saying you are not having pain, but that the pain is not caused by your heart."

The UGA research was done in collaboration with Children's Healthcare of Atlanta and Emory University and the results of the study were published Nov. 5 in the Journal of Pediatric Psychology.

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