Systematic review with meta‐analysis: selective serotonin reuptake inhibitors for noncardiac chest pain

Atluri, Dileep; Chandar, Apoorva K.; Fass, Ronnie; Falck‐Ytter, Yngve

doi:10.1111/apt.13015

Cited by 17 publications

(14 citation statements)

References 33 publications

(39 reference statements)

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“…A meta-analysis of all randomized controlled trials comparing SSRIs to placebo in patients with NCCP demonstrated that SSRIs were not superior to placebo in improving chest pain or depression symptoms. 87 The authors pointed out to the need of larger trials with longer follow-up periods.…”

Section: Selective Serotonin Reuptake Inhibitorsmentioning

confidence: 99%

Diagnosis and Management of Functional Chest Pain in the Rome IV Era

Fass

Shibli

Tawil

2019

J Neurogastroenterol Motil

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Functional chest pain accounts for about a third of the patients with noncardiac chest pain. It is a very common functional esophageal disorder that remains even today a management challenge to the practicing physician. Based on the definition offered by the Rome IV criteria, diagnosis of functional chest pain requires a negative workup of noncardiac chest pain patients that includes, proton pump inhibitor test or empirical proton pump inhibitor trial, endoscopy with esophageal mucosal biopsies, reflux testing, and esophageal manometry. The mainstay of treatment are neuromodulators that are primarily composed of anti-depressants. Alternative medicine and psychological interventions may be provided alone or in combination with other therapeutic modalities.

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Section: Selective Serotonin Reuptake Inhibitorsmentioning

confidence: 99%

Diagnosis and Management of Functional Chest Pain in the Rome IV Era

Fass

Shibli

Tawil

2019

J Neurogastroenterol Motil

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“…78 From a psychopharma-cological standpoint, a recent meta-analysis of trials evaluating selective serotonin reuptake inhibitors (SSRIs) for the treatment of NCCP concluded that SSRIs were not superior to a placebo in improving symptoms of chest pain, suggesting that psychopharmacology alone is unlikely to be a sufficient management approach for NCCP. 79 Notably, 3 of 4 studies included in the meta-analysis excluded patients with comorbid psychiatric disease; as a result, this meta-analysis does not speak to the efficacy of SSRIs in patients with NCCP who have comorbid SSRI-responsive psychiatric conditions (e.g., MDD). Although serotonin-norepinephrine reuptake inhibitors have been used for analgesia in pain syndromes such as diabetic peripheral neuropathy, 80 fibromyalgia, 81 and osteoarthritis, 82 their application in patients with NCCP has not been thoroughly evaluated.…”

Section: Interventions To Treat Nccpmentioning

confidence: 99%

Non-cardiac Chest Pain: A Review for the Consultation-Liaison Psychiatrist

et al. 2017

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Background Patients presenting with chest pain to general practice or emergency providers represent a unique challenge, as the differential is broad and varies widely in acuity. Importantly, most cases of chest pain in both acute and general practice settings are ultimately found to be non-cardiac in origin, and a substantial proportion of patients experiencing non-cardiac chest pain (NCCP) suffer significant disability. In light of emerging evidence that mental health providers can serve a key role in the care of patients with NCCP, knowledge of the differential diagnosis, psychiatric co-morbidities, and therapeutic techniques for NCCP would be of great use to both consultation-liaison (C-L) psychiatrists and other mental health providers. Methods We reviewed prior published work on (1) the appropriate medical workup of the acute presentation of chest pain, (2) the relevant medical and psychiatric differential diagnosis for chest pain determined to be non-cardiac in origin, (3) the management of related conditions in psychosomatic medicine, and (4) management strategies for patients with NCCP. Results We identified key differential diagnostic and therapeutic considerations for psychosomatic medicine providers in 3 different clinical contexts: acute care in the emergency department, inpatient C-L psychiatry, and outpatient C-L psychiatry. We also identified several gaps in the literature surrounding the short-term and long-term management of NCCP in patients with psychiatric etiologies or co-morbid psychiatric conditions. Conclusions Though some approaches to the care of patients with NCCP have been developed, more work is needed to determine the most effective management techniques for this unique and high-morbidity population.

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“…Commonly diagnosed with no clear etiology, patients describe a radiating pain throughout the neck, mid-chest, and mid-back with a debilitating pressure sensation not of burning quality (Nasr et al, 2010). Similarly to its role in functional heartburn, esphageal hypensensitivity is likely at play in the presentation of symptoms (Miwa et al, 2010; Nasr et al, 2010; Rao, Hayek, & Summers, 2001), therefore pain modulators such as TCAs, SSRIs, SNRIs have been prescribed, but based on potential side effects should be cautiously used (Atluri, Chandar, Fass, & Falck-Ytter, 2015; Clouse et al, 1987). There have been promising outcomes in terms of psychological treatment for FCP/NCCP where cognitive behavioral therapy (CBT) (Klimes, Mayou, Pearce, Coles, & Fagg, 1990) and HYP proved superior to placebo controls in decreasing symptoms.…”

Section: Condition-specific Applicationsmentioning

confidence: 99%

Hypnotherapy for Esophageal Disorders

Riehl

Keefer

2015

American Journal of Clinical Hypnosis

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Hypnotherapy is an evidence based intervention for the treatment of functional bowel disorders, particularly irritable bowel syndrome. While similar in pathophysiology, less is known about the utility of hypnotherapy in the upper gastrointestinal tract. Esophageal disorders, most of which are functional in nature, cause painful and uncomfortable symptoms that impact patient quality of life and are difficult to treat from a medical perspective. After a thorough medical workup and a failed trial of proton pump inhibitor therapy, options for treatment are significantly limited. While the pathophysiology is likely multifactorial, two critical factors are believed to drive esophageal symptoms—visceral hypersensitivity and symptom hypervigilance. The goal of esophageal directed hypnotherapy is to promote a deep state of relaxation with focused attention allowing the patient to learn to modulate physiological sensations and symptoms that are not easily addressed with conventional medical intervention. Currently, the use of hypnosis is suitable for dysphagia, globus, functional chest pain/non-cardiac chest pain, dyspepsia, and functional heartburn. In this article the authors will provide a rationale for the use of hypnosis in these disorders, presenting the science whenever available, describing their approach with these patients, and sharing a case study representing a successful outcome.

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Systematic review with meta‐analysis: selective serotonin reuptake inhibitors for noncardiac chest pain

Abstract: SUMMARY BackgroundSelective serotonin reuptake inhibitors (SSRIs) are used to treat noncardiac chest pain (NCCP) symptoms, however, data regarding their efficacy remains inconclusive.

Cited by 17 publications

References 33 publications

Diagnosis and Management of Functional Chest Pain in the Rome IV Era

Diagnosis and Management of Functional Chest Pain in the Rome IV Era

Non-cardiac Chest Pain: A Review for the Consultation-Liaison Psychiatrist

Hypnotherapy for Esophageal Disorders

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