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Objective: The aim of this study was to compare men and women with unexplained chest pain (UCP) to a randomly selected population sample free of clinical heart disease with regard to sleep problems, mental strain at work, stress at home, negative life events and health-related quality of life (HRQOL)., Design and Subjects: The study was conducted at a university hospital in Sweden including 231 patients aged 25-69 without any organic cause for chest pain. As a reference group, 1069 participants, were recruited from the INTERGENE population-based study., Results: Patients with UCP had more sleep problems (OR = 1.8, P < 0.0001), were almost three times more worried about stress at work (OR = 2.9, P < 0.0001), or had more stress at home (OR = 2.8, P < 0.0001), and were twice as likely to have negative life events (OR = 2.1, P < 0.0001). Women, but not men, with UCP, had a higher prevalence of cardiovascular risk factors (obesity, smoking, diabetes and hypertension) compared with references. With regard to HRQOL, UCP patients scored significantly lower than references in all dimensions of the SF-36., Conclusions: In comparison with a healthy reference group, patients with UCP reported more sleep problems, mental strain at work, stress at home and negative life events and had lower health-related quality of life. Aside from immigration the strongest independent psychosocial factors were mental strain at work and negative life events last year in men and stress at home in women.

Background: Unexplained chest pain is a frequent and increasingly common complaint among patients admitted to Emergency Departments. Previous studies have defined unexplained chest pain as non-cardiac or non-coronary artery disease, i.e. patients with other organic causes explaining the chest pain could be included. To increase the knowledge of unexplained chest pain, this study only includes patients without any known explanation for their chest pain., Aim: To analyze gender differences regarding pain characteristics, psychosocial factors and health-related quality of life among patients diagnosed unexplained chest pain., Methods and Results: The results are based on 179 patients (101 men, 78 women) between 16 and 69 years old (mean age 45.3) consecutively admitted to Emergency Department. Pain characteristics were assessed by Pain-O-Meter. Social relationships, depression, anxiety, and health-related quality of life were measured by a self-administered questionnaire. There were no gender differences regarding chest pain intensity; however women described their pain as burning (p<0.01) and frightening (p<0.03) more often than men. Men reported less depression (p<0.01) and less trait anxiety (p=0.01) than women. Chest pain intensity did not significantly impact health-related quality of life except physical functioning in men (p=0.05)., Conclusion: Gender differences were few. Chest pain intensity did not significantly impact health-related quality of life.

Background: Little scientific attention has been paid to providing a comprehensive multidimensional description of chest pain in patients with unexplained chest pain., Aims: The aims of the present study were: (1) to describe the symptom chest pain, including the dimensions of intensity, quality, duration and location in patients with unexplained chest pain (UCP); and (2) to identify similarities and differences in how patients with UCP and patients with ischemic heart disease (IHD) describe chest pain., Method: A descriptive, correlational and comparative design. Totally 208 consecutive UCP patients and 40 IHD patients below 70 years of age participated. Pain was assessed using the instrument Pain-O-Meter., Results: The occurrence of chest pain was 79% (n=165) in UCP patients versus 60% (n=22) in the IHD patients (p=0.001). Patients with UCP reported greater pain intensity and used more sensory and affective words than IHD patients (p<0.01). Relationships between pain location and amount of body surface involved in the pain and pain intensity in both groups were found (p<0.001)., Conclusions: Our results showed some defining characteristics of the UCP group, but the many similarities between the two groups in their experience of chest pain made it impossible to clearly differentiate the groups' pain profiles.

Background: Patients with unexplained chest pain have seldom organic pathology. Although both physical and psychological factors have been studied and suggested as causes of chest pain., Aim: The aim was to describe the experience of unexplained chest pain and its influence on daily life situation in men and women., Methods: Nine women and eleven men with unexplained chest pain, aged 31-62 years were interviewed. A qualitative descriptive design was used. The interviews were analyzed by content analysis focusing on experience by gender., Results: The results embraced two domains descriptions and consequences of chest pain and daily life situation. Words like pressure, cramp, strong, or burning were used in the descriptions of the chest pain experienced with more similarities than variations between men and women. Physical, psychological and social consequences due to chest pain influenced daily life. The men specifically reported having a 'fast tempo' in their lives, with stress at work being seen as a feature experienced by both men and women., Conclusions: This study shows that men and women had more similarities than variations in descriptions of chest pain. Their unexplained chest pain influenced their functions in daily life that led to, especially for the men, few contacts outside the family and therefore a weak social network.

Aim: The aim was to describe patients' experience of unexplained chest pain, and how the pain affected their everyday life., Background: Chest pain is one of the most common reasons for patients to consult the emergency department. Often no clear ischaemic heart disease or any other somatic explanation is found. Exploring the pain experience and how the pain affects everyday life may provide insights into the patients' perspective, fill the gaps in our knowledge about this condition and give needed direction for nursing practice., Method: The study sample (n = 19) included 11 men and eight women admitted to the emergency department. An open-ended unstructured interview was conducted with each patient and the data were analysed using content analysis., Results: The categories concerning pain include the informants' descriptions of several aspects of pain. These aspects are described in four categories and four subcategories: (i) pain location, (ii) pain duration with the subcategories 'periodic pain' and 'continuous pain', (iii) pain intensity, (iv) quality of pain with the subcategories 'sensory aspects' and 'affective aspects' . The content of pain experience in everyday life was divided into four subthemes and was further abstracted into a theme. Four subthemes, each comprising several meaning units, were created and labelled: (i) fear and anxiety, (ii) feeling of uncertainty, (iii) feeling of stress, and (iv) loss of strength. In these descriptions, it was obvious that chest pain considerably disturbed and affected the informants' lives and an overall theme 'intrusion into the everyday life world' emerged., Conclusion: The results of this study show that unexplained chest pain intrudes into everyday life in a destructive manner that cannot be ignored., Relevance to Clinical Practice: Patients are not receiving optimal care to relieve their pain and there is therefore a need for specialized nurses who can give adequate help and support.

Background: Acute myocardial infarction (AMI) will not develop in a large proportion of patients admitted to the coronary care unit because of suspected AMI., Objective: To evaluate whether patients with confirmed AMI use different words to describe their pain than patients in whom AMI was not confirmed., Design: A retrospective descriptive design., Methods: The Pain-O-Meter, a verbal pain scale composed of 12 sensory and 10 emotional word descriptors, was used to assess pain., Setting: Coronary care unit in Sahlgrenska Hospital in Goteborg, Sweden., Subjects: A convenience sample of 889 consecutive patients admitted to the coronary care unit because of suspected AMI., Results: SENSORY COMPONENT--patients with confirmed AMI differed from those without AMI in the use of the words "pricking" (12% vs 17%; p < 0.05) and "tearing" (11% vs 6%; p < 0.05). No difference was found in the remaining 10 words. Affective components--Patients with confirmed AMI differed from those without AMI in the use of "terrifying" (29% vs 18%; p < 0.001), "intolerable" (16% vs 10%; p < 0.01), and "worrying" (48% vs 59%; p < 0.01). Women used stronger word descriptors more frequently than men., Conclusion: The use of specific or more word descriptors to separate patients with AMI from those without AMI was not supported by the study data. Although patients with AMI more frequently used the sensory word tearing as well as the affective words terrifying and intolerable and less frequently used the sensory word pricking and the affective word worrying than patients without AMI, the differences do not suggest a clinical profile that can be used to differentiate these clinical entities.

In 47 patients admitted to the coronary care unit (CCU) at Sahlgren's Hospital in Göteborg, Sweden, due to acute myocardial infarction (MI) the intensity of pain independently assessed by the patient and by the nurse on duty was evaluated during the first 24 hours in CCU. Pain was assessed according to a modified numerical rating scale graded from 0-10, where 0 meant no pain and 10 meant the most severe pain. A positive correlation between the patients' and nurses' assessments was found (r = 0.76; P less than 0.001). However, the nurses under-estimated the patients' pain in 23% of the situations and over-estimated it in 20%. Over-estimation was particularly found when heart rate and blood pressure increased. Many patients scoring their pain to fairly high degrees were not given pain-relieving treatment. Treatment with morphine did not cause substantial pain relief in a substantial number of patients. A significantly positive correlation was found between the patients' and nurses' assessments of pain, although under-estimation as well as over-estimation occurred. A few patients with severe pain were not treated and when treatment was given it was often ineffective.