Background
Recurrent heart problems and, especially, chest pain in the absence of somatic heart disease is a common finding, although challenging to treat.
Objective
The authors assessed a body-oriented approach to the somatic fixation frequently seen in these patients.
Method
They conducted a controlled study to assess the effect of functional relaxation in 22 patients with non-specific chest pain. The primary outcome measures were self-reported changes on the subscales Somatization and Anxiety of the Symptom Checklist of Derogatis, as well as the subscale Cardiovascular Complaints of the Giessen Inventory of Complaints.
Results
Significant improvements of the primary outcome measures were observed in patients treated with functional relaxation, whereas no significant improvements could be seen in the control group.
Conclusion
Functional relaxation appears to be a safe and effective, non-pharmacological approach in the treatment of non-specific chest pain.
Cardiologists frequently encounter patients with chest pain;1., 2. and 3. however, in approximately 50%, no structural heart disease or other serious physical disorders are found.4 Although 2%–5% of all admissions to the Emergency Department are related to non-specific chest-pain (NSCP),5,6 the prevalence of NSCP in the community ranges from 23% to 33%.5,7
To some extent, NSCP results from over-investigation, non-indicated somatic pharmacotherapy, and other iatrogenic factors. NSCP is associated with considerable distress for patients8 and is often complicated by co-existing psychiatric disorders, such as depression or anxiety disorders.9 Also, a variety of etiological factors have been proposed, including coronary spasm, micro-vascular coronary artery disease,10 alcohol and cigarette use,11 hyperventilation,12 or esophageal dysmotility.13
Many patients with NSCP are reassured and discharged without a specific diagnosis or treatment,14 resulting in a moderate long-term prognosis of their functional disability. Treatment of NSCP patients is very challenging.15 Less than 50% of patients with NSCP benefit from the reassurance that heart disease does not exist; 75% continue to seek medical advice, and 50% consider themselves to be significantly disabled.16,17 Patients often continue to experience symptoms, and, as a result, they begin to restrict their daily activities and develop a help-seeking behavior, described as “doctor-shopping,” based on the idea noted above that reassurance alone is almost never effective.18
A variety of pharmacological interventions, including beta receptor-blockers, nitrates, calcium channel-blockers, anxiolytics and antidepressants,19,20 and psychological interventions are used for the treatment of NSCP patients. Because of the etiological importance of dysfunctional cognitions in NSCP, cognitive/behavioral-oriented approaches are recommended as appropriate interventions;16,21,22 but psychodynamic approaches are also frequently applied in such patients.
Often, complex psychosomatic treatment approaches are accompanied by patient resistance, caused by their somatic interpretation of symptoms.23 In the present study, we focused on an approach called functional relaxation (FR), which includes psychosomatic education and a relaxation technique, both of which have proven to be effective in previous clinical trials, particularly in tension headache24 and asthmatic diseases modulated by psychosomatic influences.24., 25., 26., 27. and 28.
The aim of the present study was to investigate the efficacy of an intervention with 10 sessions of FR supplemented by a short patient-education session in the treatment of NSCP. Because of the high demand of NSCP patients for additional information regarding their medical condition, a 60-minute education session was added to the relaxation sessions.29
