Psychosomatic Management of Non-Cardiac Chest Pain

Non-Cardiac Chest Pain (NCCP) describes recurrent or persistent chest discomfort in the absence of detectable cardiac pathology. Although physical investigations routinely exclude myocardial ischaemia, many patients continue to experience pain, anxiety and reduced health-related quality of life. Psychosomatic management addresses the interplay between psychological factors—such as cardiac anxiety, fear of bodily sensations and illness beliefs—and somatic symptoms. Core elements include cognitive behavioural therapy to reframe symptom interpretation, graded exposure to feared activities, physical activity promotion and psychoeducation to reduce health-related hypervigilance. Digital modalities, including internet-delivered programmes, extend reach and support self-management in primary and emergency care settings. Multidisciplinary collaboration between cardiology, psychiatry, psychology and nursing ensures that interventions are tailored to individual profiles, with stepped-care models directing more intensive therapies to those with persistent dysfunction. Globally, targeted psychosomatic strategies can reduce healthcare utilisation, improve functional outcomes and empower patients to regain control of daily activities.

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Psychosomatic Management of Non-Cardiac Chest Pain publication trend

The graph below shows the total number of articles in psychosomatic management of non-cardiac chest pain across all publications each year (not limited to Nature Index journals).

Technical terms

Non-Cardiac Chest Pain (NCCP): Chest pain without identifiable cardiac pathology following standard cardiac evaluation.

Cognitive Behavioural Therapy (CBT): A structured psychological intervention that modifies unhelpful thoughts and behaviours to reduce distress and improve coping.

Cardiac Anxiety: Excessive fear and hypervigilance about heart-related symptoms, often leading to avoidance of activities perceived as risky.

Persistent Physical Symptoms (PPS): Long-standing somatic complaints that are distressing or disabling and not fully explained by medical findings.

Health-Related Quality of Life (HRQoL): A multidimensional construct reflecting physical, psychological and social functioning as perceived by the individual.

References

1. Long-term effects and predictors of change of internet-delivered cognitive behavioural therapy on cardiac anxiety in patients with non-cardiac chest pain: a randomized controlled trial. BMC Psychiatry (2024).
2. Non-Cardiac Chest Pain as a Persistent Physical Symptom: Psychological Distress and Workability. International Journal of Environmental Research and Public Health (2023).
3. The associations between psychological distress and health-related quality of life in patients with non-cardiac chest pain. Health and Quality of Life Outcomes (2020).