This study tested the hypothesis that functional morbidity in benign chest pain can be modified independently of symptoms through interdisciplinary med ical and cognitive-behavioral intervention. Analyses used data collected in a sixteen-week trial of interdisciplinary treatment for disability in benign chest pain. One hundred four chest pain patients having normal coronary arteriograms (NCA) (n = 14) or mitral valve prolapse (MVP) with no other known cardiac or arterial disease (n = 90) were assigned to individual treatment, group treat ment, self-monitoring attention control, or a wait-list control group. Results in dicate that interdisciplinary intervention, in group or individualized format, was successful for improving short-term and long-term (follow-up range = six to sixteen months) functional status, in both MVP and NCA patients. Correlational analysis indicated that functional improvements were not dependent on reduc tions in the frequency of symptoms. In fact, significant reductions in disability were obtained in those treated patients (13 of 43) who reported no reduction, or an actual increase, in the frequency of chest symptoms. These data indicate that disability in benign chest pain may be modified independently of symptoms by an integration of medical and cognitive-behavioral strategies.
Get full access to this article
View all access options for this article.
References
1.
Lavey EB, Winkle RA: Continuing disability of patients with chest pain and normal coronary arteriograms . J Chronic Dis32:191-196, 1979.
2.
Ockene IS, Shay MJ, Alpert JS, et al: Unexplained chest pain in patients with normal coronary arteriograms . N Eng J Med303:1249-1252, 1980 .
3.
Pasternak RC, Thibault GE, Savoia M., et al: Chest pain with angiographically insignificant coronary arterial obstruction: Clinical presentation and longterm follow-up. Am J Med68:813-817, 1980.
4.
Allen H., Harris A., Leatham A.: Significance and prognosis of an isolated late systolic murmur: A 9 to 22 year follow-up. Br Heart J36:525-532, 1974.
5.
Nishimura RA , McGoon MD, Shub C., et al: Echocardiographically documented mitral valve prolapse: Longterm follow-up of 237 patients. N Engl J Med313:1305-1309, 1985.
6.
Waxler EB, Kimbiris D., Dreifus LF: The fate of women with normal coronary angiograms and chest pain resembling angina pectoris. Am J Cardio28:25-32, 1971.
7.
Proudfit WL, Bruschke Avg, Sones FM: Clinical course of patients with normal or slightly or moderately abnormal coronary arteriograms: 10-year follow-up of 521 patients. Circulation62:712-717, 1980.
8.
Rifkin BG: The treatment of cardiac neurosis using systematic desensitization. Behav Res Ther6:239-241, 1968.
9.
Pinney S., Freeman LJ, Nixon Pgf: Role of the nurse counselor in managing patients with the hyperventilation syndrome. J R Soc Med216-218, 1987.
10.
Margraf J., Ehlers A., Roth WT: Mitral valve prolapse and panic disorder: A review of their relationship. Psychosom Med50:93-113, 1988.
11.
Gaffney FA, Lane LB, Pettinger W., et al: Effects of long-term clonidine administration on the hemodynamic and neuroendocrine postural responses of patients with dysautonomia. Chest83:436-438, 1983.
12.
Cott A.: Treatment of morbidity with atypical chest pain. Can Fam Phys33:1001-1006, 1987.
13.
Cott A., McCully J., Goldberg W., et al: Efficacy of cognitive-behavioral intervention for functional morbidity in benign chest pain. Manuscript submitted for publication.
14.
Cott A.: Practical applications of the disease-illness distinction model: New concepts in health care delivery through the optimal integration of medical and behavioral sciences. Can J publicHealth77(Suppl 1):51-58, 1986.
15.
Cott A.: The disease-illness distinction: A model for effective and practical integration of behavioral and medical sciences. In: Illness Behaviour: a Multidisciplinary Approach, ed. by McHugh S, Vallis M.New York: Plenum, 1987 pp. 71-99.
16.
Fordyce WE: Behavioral methods for chronic pain and illness. St. Louis : C.V. Mosby Co, 1976.
17.
Turk DC, Holzman AD, Kerns RD: In: Self-Management of Chronic Disease, ed. by Holroyd, KA.New York: Academic Press, 1986.
18.
Meichenbaum D. : Cognitive-Behaviour Modification: An Integrative Approach. New York: Plenum, 1977.
19.
Bandura A.: Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev84:191-215, 1977.
20.
Fordyce W., Lansky D., Calsyn DA, et al: Pain measurement and pain behavior. Pain18:53-69, 1984.
21.
Linton SJ: The relationship between activity and chronic back pain. Pain21:289-294, 1985.
22.
Dolce JJ, Crocker MF, Moletteire C., et al: Exercise quotas, anticipatory concern and self-efficacy expectancies in chronic pain: A preliminary report. Pain24:365-372, 1986.
