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Hypnosis for non-cardiac chest pain
  1. O S Palsson1,
  2. W E Whitehead2
  1. 1Center for Functional Gastrointestinal and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  2. 2Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  1. Correspondence to:
    Professor W E Whitehead
    Campus Box 7555, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7555, USA; William_Whitehead{at}med.unc.edu

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Hypnosis may be an effective treatment for patients with non-cardiac chest pain that has not responded to acid inhibition

Non-cardiac chest pain (NCCP) is a condition defined by recurrent episodes of substernal chest pain suggestive of coronary artery disease in patients in whom no cardiac cause can be found after a comprehensive evaluation.1 It is aetiologically heterogeneous, and the cause in individual patients often remains unclear even after thorough investigation. Patients with NCCP are frequently not reassured by negative investigations and are persistent in their pursuit of further medical evaluations for possible cardiovascular disease. The consequent impairment in personal and occupational functioning and subjective well being can be substantial. A recent estimate places the annual cost of health care services provided in the USA to treat NCCP at 6.5 billion dollars.2

The most commonly identified cause of NCCP symptoms is gastro-oesophageal reflux disease. Consequently, a therapeutic trial of a proton pump inhibitor is often recommended to confirm the diagnosis and as the firstline treatment.3,4 However, a variety of other factors have been suggested as possible causes of NCCP in individual patients, including oesophageal dysmotility, visceral hyperalgesia, musculoskeletal problems, and psychological factors, such as anxiety and somatisation.5 When patients fail to respond to proton pump inhibitors, few treatment options remain and the results of medical management are often unsatisfactory.

In this issue of Gut, Jones and colleagues6 demonstrated in a small randomised controlled trial that hypnosis is an effective treatment for patients with NCCP that has not responded to acid inhibition (see page 1403). Following 12 sessions of individualised treatment with hypnosis, 80% of NCCP patients reported that they were “completely better” or “moderately better” compared with only 23% of patients in a control group. The controls received supportive psychotherapy and a …

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