Chest pain: a sign of psychiatric disorder?

Chest pain is a common and sometimes vexing complaint in children and adolescents. It is well-recognized that most chest pain in the pediatric population is unrelated to heart disease, but does this mean it is unimportant? In this issue of The Journal, Lipsitz et al publish the result of their investigation into whether chest pain might be associated with psychiatric disorders. They compared children 8-17 years old presenting with medically unexplained chest pain with those presenting with an innocent heart murmur. They found that anxiety and depression were more common in the children with chest pain. Chest pain was also associated with diminished quality of life. In this study, cause and effect cannot be determined. Nevertheless, these findings emphasize that when chronic medically unexplained chest pain is present in children and adolescents, primary care physicians should consider the possibility of a comorbid psychiatric disorder.