Coping strategies, stress, physical activity and sleep in patients with unexplained chest pain

BACKGROUND: The number of patients suffering from unexplained chest pain (UCP) is increasing. Intervention programmes are needed to reduce the chest pain and suffering experienced by these patients and effective preventive strategies are also required to reduce the incidence of these symptoms. The aim of this study was to describe general coping strategies in patients with UCP and examine the relationships between coping strategies, negative life events, sleep problems, physical activity, stress and chest pain intensity. METHOD: The sample consisted of 179 patients younger than 70 years of age, who were evaluated for chest pain at the emergency department daytime Monday through Friday and judged by a physician to have no organic cause for their chest pain. The study had a cross-sectional design. RESULTS: Emotive coping was related to chest pain intensity (r = 0.17, p = 0.02). Women used emotive coping to a greater extent than did men (p = 0.05). In the multivariate analysis was shown that physical activity decreased emotive coping (OR 0.13, p < 0.0001) while sex, age, sleep, mental strain at work and negative life events increased emotive coping. Twenty-seven percent of the patients had sleep problems 8 to14 nights per month or more. Permanent stress at work during the last year was reported by 18% of the patients and stress at home by 7%. Thirty-five percent of the patients were worried often or almost all the time about being rushed at work and 23% were worried about being unable to keep up with their workload. Concerning total life events, 20% reported that a close relative had had a serious illness and 27% had reasons to be worried about a close relative. CONCLUSION: Our results indicated that patients with more intense UCP more often apply emotive coping in dealing with their pain. Given that emotive coping was also found to be related to disturbed sleep, negative life events, mental strain at work and physical activity, it may be of value to help these patients to both verbalise their emotions and to become cognizant of the influence of such factors on their pain experience

Patients with unexplained chest pain − Pain experience, stress, coping and health-related quality of life

Chest pain is a common symptom that causes individuals to seek acute care at emergency departments; however, more than half of these patients are judged to have no organic cause to their pain. In Sweden, the number of patients discharged from hospital with a diagnosis of unexplained chest pain (UCP) has increased from 8,432 in 1987 to 17,555 in 2005. There are limited descriptions in the literature of the pain experience or of psychosocial factors which explain the development and maintenance of UCP. The overriding aim of this thesis was to provide a comprehensive assessment of UCP. Further aims were to determine psychosocial factors associated with UCP and how the chest pain experiences affect everyday life and health-related quality of life (HRQOL). The thesis consists of four studies: the first study describes patients’ perceptions of their experiences of UCP; the second study describes the chest pain characteristics in patients with UCP versus ischemic heart disease (IHD); and the two following studies describe and explore UCP and its relationships to mental strain at work, stress at home, negative life events, sleep, coping and HRQOL. Both quantitative and qualitative methods were used. The studies were carried out at Sahlgrenska University Hospital/Östra in Göteborg, Sweden from December 2002 to September 2003. The UCP patients explained that their pain gave rise to fear and anxiety, a feeling of uncertainty, stress and loss of strength, which to a great extent affected everyday life. They had difficulty managing activities such as household chores, socialising with friends, and taking part in recreational and sexual activity. Lacking medical explanations for their chest pain, the patients felt that they had no hope of being cured and thought they would have to live with it for the rest of their lives. The chest pain, assessed with a Pain-O-Meter, was described as pressing, stabbing, dull, worrying, troublesome and tiring. In comparison with patients with IHD, patients with UCP more frequently described their chest pain as dull, sore, annoying and troublesome. UCP patients perceived their condition as more painful than IHD patients and required more sensory and affective words to describe their pain. However, the UCP and IHD patients did not differ regarding the location of their pain. In comparison with a random population sample, patients with UCP had impaired HRQOL with lower scores in all dimensions of the SF-36. Likewise, they were more often worried about stress at work, perceived more stress at home, more often had sleep problems and had experienced more negative life events than the controls. The patients used cognitive coping strategies in managing stress, but emotional reactions to stress seemed to increase the intensity of the chest pain. A larger proportion of the UCP patients was immigrant and had a sedentary lifestyle. Women with UCP had higher levels of cardiovascular risk factors. Pain assessment and more extensive communication about how the pain affects everyday life are crucial for improved care. It is essential that ways be found to alleviate pain and to improve health and quality of life, as well as to promote physical activity and sleep

Psychosocial profile in men and women with unexplained chest pain

OBJECTIVE: The aim of this study was to compare men and women with unexplained chest pain (UCP) to a randomly selected population sample free of clinical heart disease with regard to sleep problems, mental strain at work, stress at home, negative life events and health-related quality of life (HRQOL). DESIGN AND SUBJECTS: The study was conducted at a university hospital in Sweden including 231 patients aged 25-69 without any organic cause for chest pain. As a reference group, 1069 participants, were recruited from the INTERGENE population-based study. RESULTS: Patients with UCP had more sleep problems (OR = 1.8, P < 0.0001), were almost three times more worried about stress at work (OR = 2.9, P < 0.0001), or had more stress at home (OR = 2.8, P < 0.0001), and were twice as likely to have negative life events (OR = 2.1, P < 0.0001). Women, but not men, with UCP, had a higher prevalence of cardiovascular risk factors (obesity, smoking, diabetes and hypertension) compared with references. With regard to HRQOL, UCP patients scored significantly lower than references in all dimensions of the SF-36. CONCLUSIONS: In comparison with a healthy reference group, patients with UCP reported more sleep problems, mental strain at work, stress at home and negative life events and had lower health-related quality of life. Aside from immigration the strongest independent psychosocial factors were mental strain at work and negative life events last year in men and stress at home in women