Sexual, physical, verbal/emotional abuse and unexplained chest pain

Approximately one third of patients with non cardiac chest pain (NCCP) report a history of abuse, however no data exists on the prevalence of abuse among people with unexplained chest pain in the general population. We aimed to determine if there is a relationship between childhood sexual, physical, emotional abuse and unexplained chest pain, and to identify whether any potential relationship is being driven by an association with psychological distress.

Subjects were identified from 2 previous random population surveys that included people with irritable bowel syndrome (IBS) and/or functional dyspepsia (FD) and healthy controls. People in the unexplained chest pain group (n=27) had chest pain in the past 12months that was not heartburn or heart disease. People in the comparison group (n=60) did not have chest pain for more than 12months. Self-reported abuse and psychological variables were assessed using validated measures.

Emotional/verbal abuse (20.8% versus 4.4%, P=0.032) and physical abuse (16.7% versus 2.2%, P=0.028) were significantly more common in people with unexplained chest pain versus the comparison group. Only a history of emotional/verbal abuse was a significant independent predictor of meeting criteria for unexplained chest pain (OR=5.66; 95%CI 1.01-31.80, P=0.049) even after controlling for IBS and/or FD (OR=5.45; 95%CI 0.96-30.83, P=.05), but not when depression was controlled for (OR=4.70; 95%CI 0.90-27.61), P=0.08.

A history of childhood emotional/verbal abuse is a risk factor for having unexplained chest pain but the association may be moderated by psychological distress, specifically depression.