Management of functional chest pain

Fass, 2019 Tack, 2016 George, 2016

This topic describes the management of functional chest pain. For general advice about managing functional gastrointestinal disorders, including patient support and psychiatric or psychological assessment, see Approach to managing functional gastrointestinal disorders.

Advise patients that once significant underlying causes have been excluded (especially cardiovascular causes) the prognosis is good and symptoms usually resolve with time. Anxiety is often present and may be a factor in precipitating episodes of pain.

The mainstay of reducing the frequency of functional chest pain episodes is managing anxiety (see Approach to managing functional gastrointestinal disorders). A trial of a proton pump inhibitor (PPI), a calcium antagonist or a neuromodulator may also reduce symptoms. For dosages, see:

• Management of extra-oesophageal symptoms of GORD in adults for PPIs
• Management of distal oesophageal spasm for calcium antagonists
• Neuromodulation using antidepressant drugs in functional gastrointestinal disorders for neuromodulators.