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Daily Medical Update
Non-cardiac chest pain
Friday, August 21, 2026
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🔬 Practice-Changing Findings
Evidence from RCTs and meta-analyses published in the
last 12 months.
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BMC psychiatry (2024) - Randomized Controlled Trial
Key Findings
- Compared with psychoeducation, internet-delivered CBT did not produce a statistically significant additional reduction in cardiac anxiety over 12 months.
- The CBT group had a favorable between-group effect on chest-pain frequency (p = .009) and a group effect favoring health-related quality of life (p = .03).
- Higher baseline avoidance was associated with greater improvement in cardiac anxiety at 12 months.
📋 Practice Implication: Use guided digital CBT as a symptom-management option for selected patients, particularly when avoidance and recurrent chest-pain behavior are prominent, while setting realistic expectations about cardiac-anxiety benefit beyond psychoeducation.
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Journal of pain research (2025) - Journal Article
Key Findings
- Weighted regression found significant associations between anxiety, depression, and non-cardiac chest pain; greater anxiety severity was associated with increased risk (OR = 2.778).
- Participants reporting fatigue almost every day had a 1.927-fold increased risk of non-cardiac chest pain compared with those reporting no fatigue.
- Depressive and anxious symptoms were associated with increased non-cardiac chest pain risk in multivariable analysis.
📋 Practice Implication: Add focused screening for anxiety, depression, and fatigue to the assessment of adults with non-cardiac chest pain, then link positive screens to targeted psychosocial care rather than treating the symptom as purely structural.
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ARYA atherosclerosis (2025) - Journal Article
Key Findings
- Female sex and higher education were significantly associated with increased pain severity in the 360-patient cohort.
- Depression, type D personality, somatization, cardiac anxiety, fear of bodily sensations, and poor self-rated health were associated with increased pain severity.
- The high-pain group had significantly increased psychosocial burden across multiple assessed domains.
📋 Practice Implication: For patients whose pain remains severe after cardiac causes are excluded, assess modifiable psychological and somatic-amplification factors to guide multimodal treatment and avoid escalating investigations alone.
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Pediatrics international : official journal of the Japan Pediatric Society (2025) - Journal Article
Key Findings
- Psychiatric disorders were identified in 39.3% of children with non-cardiac chest pain; generalized anxiety disorder was most common (19.7%), followed by ADHD (8.2%).
- The chest-pain group had significantly increased child-anxiety and somatization scale scores compared with healthy volunteers.
- Generalized anxiety disorder prevalence was increased in the chest-pain group compared with the control group.
📋 Practice Implication: In pediatric clinics, incorporate brief anxiety and somatization screening for unexplained chest pain and arrange mental-health evaluation when indicated, which may reduce repeated low-yield medical testing.
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Cureus (2025) - Journal Article
Key Findings
- Ineffective esophageal motility was the most common high-resolution manometry abnormality (30%), followed by distal esophageal spasm (12.5%).
- High-resolution manometry was abnormal in 45% of patients whose routine endoscopy was normal.
- Endoscopic findings did not significantly correlate with manometry results, and 45% of patients with normal endoscopy had abnormal HRM.
📋 Practice Implication: When persistent non-cardiac chest pain remains unexplained after normal endoscopy, consider high-resolution manometry to identify motility disorders that may change the diagnostic and treatment pathway.
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Summary
Recent evidence supports treating non-cardiac chest pain as a biopsychosocial and organ-specific problem: psychosocial distress is associated with occurrence and severity, while esophageal motility abnormalities may be missed by routine endoscopy. In children, psychiatric comorbidity is common, and guided internet CBT may reduce chest-pain frequency and improve quality of life even when its incremental effect on cardiac anxiety over psychoeducation is not significant.
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