Persistent pain is a significant problem for many non-cardiac chest pain patients. Although coping skills training (CST) methods have only recently been applied to the management of non-cardiac chest pain, these methods appear to be promising. After completing CST, many patients report significant reductions in pain and improvements in physical and psychosocial disability. Data from follow-up studies, however, indicate that while some patients are able to maintain treatment gains in pain, others are not. Given the advantages of CST (its low cost and minimal side effects) and its demonstrated promise, there is a need to explore new ways to help non-cardiac chest pain patients maintain and extend their initial treatment gains. The proposed study seeks to determine whether the effects of CST can be enhanced by combing it with Sertraline-a psychotropic medication that we have recently found in preliminary research can significantly decrease pain in non-cardiac chest pain patients. In the proposed study, 200 non-cardiac chest pain patients will be randomly assigned to four conditions: a) CST plus Sertraline, b) CST plus placebo, c) Sertraline alone, and d) Placebo alone. Outcome measures will be collected before and after the 10 week treatment phase of the study and at 6-months post-treatment. The study: 1) will evaluate whether a protocol that combines CST with Sertaline helps patients maintain gains in pain, physical disability, psycholosocial disability, and 2) will determine how changes in patients' pain-related catastrophizing and daily use of coping skills relate to long-term (6 months) improvements in pain and disability. If CST plus Sertraline is effective, future studies could evaluate the efficacy of this biobehavioral protocol for other populations having persistent pain (e.g. osteoarthritis, sickle cell disease, or cancer). Future studies could also identify the particular components of CST (e.g. training in attention diversion methods, behavioral coping strategies, or cognitive restructuring) that contribute most to treatment effects. By isolating the active ingredients of this training, one can streamline it. making it more cost-effective and thus more readily available to the large population of non-cardiac chest pain patients. The study proposed rigorously evaluates methods for enhancing the effects of coping skills training and Sertraline in non-cardiac chest pain patients. This study may lead to major advances in our understanding of non-cardiac chest pain and enlarge our repertoire of methods for effectively treating non-cardiac chest pain.
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