Effects of coping skills training and sertraline in patients with non-cardiac chest pain: A randomized controlled study

Abstract

Non-cardiac chest pain (NCCP) is a common and distressing condition. Prior studies suggest that psychotropic medication or pain coping skills training (CST) may benefit NCCP patients. To our knowledge, no clinical trials have examined the separate and combined effects of CST and psychotropic medication in the management of NCCP. This randomized clinical trial examined the separate and combined effects of CST and antidepressant medication (sertraline) in participants with non-cardiac chest pain. A sample of individuals diagnosed with NCCP was randomly assigned to one of four treatments: (1) CST plus sertraline (CST + sertraline), (2) CST plus placebo (CST + placebo), (3) sertraline alone, or (4) placebo alone. Assessments of pain intensity, pain unpleasantness, anxiety, pain catastrophizing, depression, and physical disability were collected prior to treatment, and at 10- and 34-weeks following randomization. Data analyses revealed that CST and sertraline either alone or in combination significantly reduced pain intensity and pain unpleasantness. The combination of CST plus sertraline may have the greatest promise in that, when compared to placebo alone, it not only significantly reduced pain but also pain catastrophizing and anxiety. Overall, these findings support the importance of further research on the effects of CST and sertraline for non-cardiac chest pain.

Interdisciplinary team-based care for patients with chronic pain on long-term opioid treatment in primary care (PPACT) – Protocol for a pragmatic cluster randomized trial

“…This approach is consistent with chronic care models of care [38–42], previous collaborative care and interdisciplinary behavioral approaches to the management of chronic pain [27,35,43–46], the many studies done on the pain coping skills training approach [29,30,47–49], and chronic pain treatment guideline criteria [50–52]. A visual depiction of patient flow through the intervention is shown in Fig.…”

Effects of Antidepressants in Patients With Functional Esophageal Disorders or Gastroesophageal Reflux Disease: A Systematic Review

“…In the literature identified by this systematic search, the percentage of symptom reduction ranged from 18% to 67% for the treatment of functional chest pain. [17][18][19][20][21][22][23][24] For the treatment of heartburn this percentage ranged from 23% to 61%. [26][27][28][29] Unfortunately, considerable differences between the selected studies regarding the patient definition, outcome definition, and the method of symptom analysis hampered the meta-analysis of the data presented.…”

“…A cardiac etiology and gastroesophageal reflux must be excluded, as well as other histopathology-based motility disorders such as achalasia. We identified 8 randomized, placebocontrolled trials evaluating antidepressant therapy for noncardiac chest pain, of which 6 trials were discussed extensively in a systematic review by Nguyen et al [17][18][19][20][21][22][23][24][25] The primary outcome measures in these 8 trials varied considerably, but in all trials the frequency, intensity, or duration of chest pain was evaluated. Although currently a part of the Rome III diagnostic criteria, exclusion of GERD was performed in only 2 studies, by Lee et al 22 and Clouse et al 17 Favorable results were obtained in 5 studies, whereas in the other 3 studies no beneficial effect was observed compared with placebo ( Table 2).…”

Occupancy of serotonin transporter by tramadol: a positron emission tomography study with [11C]DASB

“…More recently, it was reported that emotion and pain are closely linked through the 5-HT system (Bushnell et al, 2013). Selective serotonin reuptake inhibitors (SSRIs), one category of antidepressants, have been reported to exert an analgesic effect by influencing emotion (Keefe et al, 2011). Like SSRIs, occupying 5-HTT in human brain with tramadol would have some kind of influence on emotion via the 5-HT system.…”