The independent association of anxiety with non-cardiac chest pain

Non-cardiac chest pain (NCCP) is common in clinical cardiology. Anxiety is an important factor in NCCP because of its role in the neurobehavioural processes of pain regulation. It is not well established that which specific anxiety symptoms are disproportionately elevated in NCCP and whether the association between anxiety and NCCP is independent of personality factors. Participants with NCCP (N=46; mean age 44.9 +/- 14.7; 67% women) were evaluated for anxiety (Spielberger State-Trait Anxiety Inventory[STAI]), clinical measures and personality factors (negative affectivity and social inhibition measured by the Type D inventory). Item analysis was conducted for each of the anxiety symptoms. A healthy reference group was used for comparison purposes (N=1233; mean age 55.2 +/- 14.3; 50% women). Results showed that NCCP was associated with elevated anxiety levels (STAI45) compared to the reference group (OR=3.27, 95% CI=1.68-6.36; p<.001). Item analyses revealed that all anxiety symptoms were associated with NCCP (median rho=.125, range .08-.18), particularly worry, tension and feeling frightened. Associations between anxiety and NCCP remained significant when adjusting for demographic, clinical and personality factors (OR=2.52; 95% CI=1.17-5.40). It is concluded that anxiety is strongly associated with NCCP. This association is not limited to physical anxiety symptoms and is independent of personality factors.