Study Associates Anxiety in Children to Chest Pain

It is a frightening experience for parents when any child complaints of chest pain. This symptom in children is rarely life-threatening or cardiac in nature.

Normally chest pains can indicate serious medical conditions that require a doctor's evaluation. In adults, pain in the chest is often linked to a cardiac problem. In children, however, less than 2 percent of patients receive a cardiac diagnosis for their pain.

A recent study conducted at the University of Georgia noticed that psychological factors can have more impact on pediatric chest pain than physical ones.

This research conducted by the UGA psychologists was done in collaboration with Children's Healthcare of Atlanta and Emory University.

These psychologists discovered that children diagnosed with non-cardiac chest pain have higher levels of anxiety and depression than those diagnosed with normal turbulent blood flow.

"The fact that these psychological symptoms are higher in non cardiac chest pain patients suggests the psychological symptoms may be playing a role in the presentation of chest pain," said Jennifer Lee, a doctoral candidate in the UGA Franklin College of Arts and Sciences and the study's lead author.

According to Lee it is not clear if the anxiety triggered the pain or if pain caused the anxiety in the sample group.

"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," said study co-author Ronald Blount, a psychology professor in the Franklin College.

For this study the researchers included 129 patients that belonged to the age group 8 to 18. Their survey was conducted before the diagnosis. All patients were essentially in the same situation -sitting in a cardiology office awaiting their unknown medical diagnosis.

"We are highlighting that psychology has a part in these symptoms," Blount said, "and screening for psychological, as well as medical factors, is one implication we foresee coming from this investigation."

The Sibley Heart Center at Children's Healthcare of Atlanta, one of the largest pediatric heart centers, at least 2,500 new patients come each year with acute chest pain.

"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," said Dr. Robert Campbell, chief of the Sibley Heart Center and division director of the department of pediatrics at the Emory University School of Medicine.

It was noticed that the level of functional disability-or the inability to participate in everyday activities in non cardiac chest pain patients was high. And they spent less time at school and were less involved in extra-curricular activities.

"These kids also report greater levels of physical symptoms with unclear causes, like joint pain, stomach aches, headaches," Lee said. "These symptoms are believed to be psychological manifestations of stress. Sometimes your brain doesn't tell you that you are stressed out, but your body does, so you will experience symptoms like these."

Pediatric patients with non cardiac chest pain also reported higher levels of anxiety sensitivity, a fear of experiencing physical symptoms and additionally fearing that those symptoms are related to a catastrophic health issue.

"Psychological functioning is heavily related to pain," Blount said. "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."

Lee said. "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."

"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," Campbell said. "We've learned to pay attention and to be confident and reassuring. I need to make it clear to my patients and their parents that I'm not saying you are not having pain, but that the pain is not caused by your heart."

he results of the study were published Nov. 5 in the Journal of Pediatric Psychology.