Randomized trial of sertraline in patients with unexplained chest pain of noncardiac origin

Background Between 10% and 30% of patients with symptoms similar to angina and sufficient to justify cardiac catheterization are found to have normal coronary angiograms. Treatment of patients with chest pain with no apparent cardiac cause is a major clinical problem. Our hypothesis was that sertral ine would reduce the severity of pain in patients with chest pain of noncar diac origin. Methods and Results This was a single-site, double-blind, placebo-controlle d study of the efficacy, tolerability, and safety of sertraline in the trea tment of noncardiac chest pain in outpatients. Thirty patients were enrolle d in the study. After 1 week of single-blind placebo washout, patients were randomly assigned in a double-blind fashion either to drug or placebo. The Beck Depression Inventory was administered at baseline and at completion o f study. Daily pain diaries (visual analogue scale, rating pain on a scale of 1 to 10) were selfadministered and evaluated at baseline and at follow-u p visits. Statistical measures were performed with an intention-to-treat ap proach. Patients who received sertraline over the course of the study showe d a statistically significant reduction in pain compared with those who wer e receiving placebo. Conclusions The use of sertraline in patients with noncardiac chest pain pr oduced clinically significant reduction of deity pain. These results sugges t the need for further studies of the efficacy and tolerability of sertrali ne and other selective serotonin reuptake inhibitors in the long-term manag ement of noncardiac chest pain.