Pediatric chest pains may be influenced as much or more due to psychological factors
A recent study from psychologists at the University of Georgia had found pediatric patients diagnosed with noncardiac chest pain have higher levels of anxiety and depression in comparison to patients diagnosed with innocent heart murmurs.
Jennifer Lee, graduate student clinical psychology program and doctoral candidate in the University of Georgia Franklin College of Arts and Sciences and lead author of study commented in a university release “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.”
For this study researchers examined the occurrence of internalizing symptoms and functional disability in children with noncardiac chest pain (NNCP) compared with children with innocent heart murmurs (IHMs).
This study included 129 patients aged eight to eighteen (67 had NNCP and 62 with IHMs) that were recruited from pediatric cardiology offices. Children and parents completed measures of psychological functioning and functional disability during a first visit to the cardiologist before diagnosis. All patients were in the same situation; sitting in a cardiology office awaiting their unknown medical diagnosis.
Children with NNCP reported higher levels anxiety, depression and anxiety sensitivity and also reported along with their parents higher levels of functional disability and somatization (a psychiatric condition marked by multiple medically unexplained physical, or somatic, symptoms).
The study’s results showed a statistically significant increase in anxiety and depression among patients that were later diagnosed with noncardiac chest pains. It is not clear if the anxiety is the cause of the pain or if the pain had caused the anxiety said Lee.
Dr. Ronald Blount, PhD, professor clinical program, department of psychology at Franklin College and co-author of study comments “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.” “We are highlighting that psychology has a part in these symptoms, and screening for psychological, as well as medical factors, is one implication we foresee coming from this investigation.”
Chest pain in children and adolescents is common, but is generally benign. Cardiac causes of chest pain are rare. In kids, chest pain is very rarely due to a heart problem.
The Children’s Healthcare of Atlanta Sibley Heart Center is one of the top pediatric cardiac programs in the country. It is ranked number six among the nation for pediatric hospitals and is one of the highest volume pediatric heart centers in the country.
Dr. Robert Campbell MD, Chief of Cardiac Services, Director Sibley Heart Center Cardiology, Division Director of Pediatric Cardiology, Professor of Pediatrics at Emory University School of Medicine commented “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.”
The study also observed NNCP patients had a higher level of functional disability or the inability to take part in everyday activities such as making through the day without taking a nap or running across a football field. It was also found that NNCP patients spend less time in school and less involved in after school activities.
“These kids also report greater levels of physical symptoms with unclear causes, like joint pain, stomach aches, headaches remarks Lee. She further states “Sometimes your brain doesn’t tell you that you are stressed out, but your body does, so you will experience symptoms like these.”
According to Dr. Blount “Psychological functioning is heavily related to pain.” 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 says Lee. “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.”
In their conclusion researchers wrote “Consideration of psychosocial influences on NCCP would likely be beneficial in aiding assessment and treatment.”
In closing Dr. Campbell stated “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. He further notes that doctors need to make it clear to patients and their parents that they are not saying that they do not have pain but the pain is not caused by their hearts.
This study appears in the Journal of Pediatric Psychology.
Last year a study published in the November issue of Pediatrics had also found that chest pain in children was not serious and most of the children with chest pain in the study had been discharged and none had died due to noncardiac chest pain.
The common causes for the chest pain in that study had included musculoskeletal distress and anxiety.
More information on chest pain in children and teens can be found online at The Children’s Hospital of Philadelphia.
The Children’s Hospital of Philadelphia was ranked No. 1 in more specialties than any other pediatric hospital in the nation, earning it top honors in U.S.News & World Report’s 2012-13 survey of Best Children’s Hospitals.