Internet-based CBT in patients with non-cardiac chest pain - design of a randomized controlled pilot study

Introduction: The majority of the patients seeking medical care due to chest pain are admitted for in-hospital cardiac "rule out" observation, but only one third of all patients have ischemic heart disease. More than half of these patients are diagnosed as "non-cardiac chest pain" (NCCP). Patients with NCCP utilize a substantial amount of healthcare resources, and contribute to high costs for society. Patients with NCCP may be suffering from pain-related fear and inappropriate health beliefs leading to avoidance of physical activities that they think could be harmful to their hearts. We hypothesize that these patients will gain from evaluating the accuracy and usefulness of their thoughts, and shifting their cognitive appraisals from unhealthy and maladaptive to constructive and adaptive. Purpose: To test the feasibility and effectiveness of an intervention based on CBT supporting patients to handle chest pain and related emotions, reactions and thoughts. Methods: A total of twenty patients will be recruited to this randomized controlled pilot study planned to start in April 2014. Eligible for the study will be persons over the age of 18 who during the last 6 months had sought care at least twice due to non-cardiac chest pain, and who screened positive for bodily sensations and/or avoidance of physical activity. The intervention will be a guided 4 weeks internet-based CBT programme with the following content: •Information to increase patients’ knowledge of chest pain and its impact on daily life. •Reflection upon the strategies patients use and how these can change to facilitate management of chest pain, and related emotions, reactions and thoughts. •Tailored moderate physical activity, 30 minutes per day, to get reassured that the heart tolerates physical activity and to decrease pain-related fear. •Relaxation exercise, 15 minutes per day, that can be used to cope with general stress and if appropriate to use in relation to chest pain. The control group will receiv