Home Hypnotherapy for Refractory Functional Chest Pain: A Pilot Study

The primary aim is to develop and test the feasibility of a standardized digital audio home-hypnotherapy (HHT) program for patients with refractory functional chest pain (FCP).

The secondary aims of this study are:

1. To obtain pilot data to assess the magnitude of the treatment effect of self-hypnosis in refractory FCP for an anticipated future, larger treatment trial;
2. To determine the stability of the treatment effect of HHT in refractory FCP;
3. To assess the relationship between response to HHT and psychological factors; and
4. To assess the relationship between response to HHT and symptomatic dimensions of chest pain (severity, frequency, and duration).
5. To assess the difference

Eligible patients with refractory FCP will be randomized to one of 2 arms: the active treatment group, who will receive the HHT program; or a control group. Patients in the active treatment group will receive the 12-week digital audio HHT program. This protocol consists of 7 sessions, each approximately 30-40 minutes, administered every 2 weeks, for a cumulative 12 weeks of treatment, along with a shorter (approximately 12 minute) session administered daily. Patients in the control group will receive a digital audio educational program. Subjects in both groups will be assessed at baseline, 4-6 weeks into treatment, at the end of the treatment, and 3 months after conclusion of the program. Global change in symptoms will be assessed with a 7-point Likert scale. Patients will be considered to respond if they have significant improvement on the Likert scale at the post-treatment visit. Patients will complete a chest pain symptom diary, the SCL-90 and the Coping Strategies Questionnaire-Catastrophizing subscale to assess psychological features, and the SF-36 as a measure of Health Related Quality of Life (HRQOL).

Eligibility Criteria:
Inclusion Criteria:

* Age 18 to 80, male or female.
* Patients must fulfill the Rome III criteria for Functional Chest Pain of Presumed Esophageal Origin for the previous 3 months (with symptom onset at least 6 months before diagnosis), including all of the following:

  * Midline chest pain or discomfort that is not of burning quality
  * Absence of evidence that gastroesophageal reflux is the cause of the symptom
  * Absence of histopathology-based esophageal motility disorders
* Persistent symptoms despite a trial of antidepressant therapy, as defined by either:

  * chest pain despite at least a continuous 4-week trial of at least one antidepressant within the last 6 months; or
  * intolerance of at least one antidepressant within the last 6 months.
* Negative cardiac evaluation (negative cardiac stress test or negative coronary angiogram)
* Negative gastrointestinal evaluation for cause of the pain, defined by absence of Los Angeles grade C or D erosive esophagitis on endoscopy, persistent chest pain on PPI therapy, and no association of chest pain with reflux episodes on an ambulatory pH or pH-impedance study, defined as a symptom index \<50% or symptom association probability \<95% for chest pain .

Exclusion Criteria:

* Severe co-morbid illness (cardiac, pulmonary, renal, hematologic, hepatic)
* Prior treatment with hypnosis/hypnotherapy for a medical condition
* Prior major thoracic surgery
* Prior diagnosis of or treatment for dissociative disorders, post-traumatic stress disorder, borderline personality disorder, or other psychiatric disorders that include psychotic features
* Pregnancy or planned pregnancy within the upcoming 3 months
* Inability or unwillingness to give informed consent