Editor,—Non-cardiac chest pain is a major problem in general practice, in outpatients, and on the wards. Some patients are “reassured” that their pain is not cardiac but this is of course not the end of the matter. Professor Mayou and others1-3 have demonstrated that these patients are still in trouble at follow up. Some are given the label “musculoskeletal” but this is not very convincing without a clear explanation. I suggest that this diagnosis can be supported in many cases by demonstrating reproduction of the pain by passive spinal movements. Production of symptoms by passive movements is well known to orthopaedic specialists.4 Flexion, extension, lateral flexion, and rotation of the …