Failure of a negative exercise test to reassure patients with chest pain.

Seventy-two patients with chest pain and negative exercise tests were observed. Twenty-one (29 per cent) became pain free but 51 (71 per cent) continued to complain of chest pain. Patients with persistent pain were significantly more anxious and depressed at presentation and later compared with those who had become pain free. Anxiety and particularly depression, at presentation and later, were significantly associated with severe symptoms. Patients with chest pain associated with neurosis and depression are not reassured by physiological stress testing because their physical symptoms are a feature of underlying psychiatric disease.