Understanding Pediatric Chest Pain and Other Symptoms
Condition: Chest Pain
MeSH terms: Chest Pain
Study type: Observational

Summary: 
      The causes of pediatric pain are often not the same for every child. Most children who visit
      a cardiology specialist with complaints of chest or other somatic pain have no known medical
      diagnosis to explain their symptoms. These children and their families often leave with no
      explanation for the child's distress.

      This early study will ask parents and children specific questions related to the stress in
      their lives, their emotional well-being and the children's physical functioning. The
      investigators want children who experience chest and other somatic pain, and those who do
      not, to be in their study so that they can look at both groups.

      The investigators hope to use these answers to better inform cardiologists who often work
      with children with non-cardiac pain and, in turn, help them to better serve their patients.
      Ultimately, the investigators hope that the answers they get will provide answers to these
      families. They also hope to use the results of this study to put together a short screener
      for the cardiologist to give to pediatric patients with complaints of chest or other somatic
      pain to help the cardiologists better understand their patients' symptoms.
    

Detailed description: 
      The current investigation will address some similar factors considered in prior research, but
      will considerably extend our understanding of how psychological, familial, and environmental
      factors influence noncardiac chest pain. In this investigation, a number of variables that
      have not been considered in prior research in this area will be included. Among these child
      variables are: the children's pain coping strategies, the children's somatization behaviors
      aside from chest pain, the children's externalizing symptoms (e.g., symptoms of ADHD,
      oppositional defiant disorder), school related problems, social competencies, parental
      perceptions of the child's vulnerability, functional disability (the degree to which chest
      pain interferes with normal daily functioning), and the child's health care utilization.
      Also, a more sensitive quantification of the children's frequency and intensity of chest pain
      will be collected, as well as information on situations in which the pain occurs. Parent
      report of child functioning and child self-report will be used to assess children's behavior.
      The parental factors to be assessed include the parents' own physical conditions and health
      care utilization, as well as the parents' psychological functioning. The amount of changes
      and stress the family as a whole has experienced in different domains will also be assessed
      as well. Measures of these constructs, as well as children's anxiety and depression (similar
      to Lipsitz et al. reviewed above) will be collected at the time of the original appointment.

      With the exception of the chest pain measure, quantification of these variables will be
      collected for both chest pain and innocent murmur patients between the ages of 8 and 18 years
      of age at the time of their initial appointment. Further, approximately one month following
      the medical assessment by the cardiologists, the parents and children will be asked to
      complete a measure of their satisfaction with the medical care they were provided, their
      health care utilization subsequent to the diagnostic cardiology appointment, their various
      somatic symptoms, and their functional disability at the one month follow-up assessment.
      Also, the chest pain patients will be asked to complete the chest pain inventory in
      conjunction with their parent.

      Between-group analyses will address how these multiple variables differ for the chest pain
      group and patients presenting for an evaluation for heart murmurs. This will be true at both
      the time of the patients' appointment and at follow-up. Further, within-group correlational
      analyses will be conducted primarily for with the chest pain group. The goal of these within
      group analyses will be to address how the various child, parent, and familial factors
      correlate with the children's chest pain symptoms, healthcare utilization, other somatic
      symptoms, and functional disability. In addition, for the chest pain group, the patients' and
      their families' functioning at the time of the initial appointment will be used to predict
      chest pain and other somatic symptom maintenance, health care utilization following the
      initial appointment, and satisfaction with their medical care at follow-up. Each of these
      questions will advance the literature in this area.

      We should also point out why the innocent murmur group was chosen as a comparison sample for
      the chest pain patients. As noted above, pain is a subjective experience that is first noted
      by the patient and then communicated to others. It is then reacted to in various ways by
      those in the child's environment. In contrast, a child with a heart murmur is not the one who
      first notices the symptom and then communicates it. Instead, the patient with a murmur is
      told that they have the symptom by a pediatrician, family practice physician, or other health
      care provider. This tendency to notice and interpret pain in a particular manner is an
      essential component in the history of the children and their families who report to
      cardiology clinics for an evaluation of the etiology of chest pain. Such noticing and
      interpretation is fundamentally a psychological process.

      Comparison: adolescents who present in a cardiac specialty clinic with noncardiac chest pain
      versus those who present with innocent murmurs.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        enrolling pediatric patients with either chest pain or innocent heart murmur referrals
      
Keywords: Innocent heart murmurs; Chest pain; pediatric Cardiology; Somatization; life stress