Spinal Cord Electrical Stimulation for Refractory Angina Treatment
Arq. bras. neurocir; 38 (4), 2019
Publication year: 2019
Cardiovascular disease (CVD) is the main cause of death worldwide, including in Brazil.
Angina pectoris is a challenging disease because its clinical manifestation is not always
related to the degree of obstruction. Visceral pain fromany source can be totally disabling.
It influences all aspects of the life of a patient and it can be one of the main causes of
absence from work and of family disruption. Spinal cord electrical stimulation (SCES) has
been traditionally applied for the treatment of neuropathic pain, with good to excellent
results. Visceral pain syndrome can be as debilitating and disabling as somatic or
neuropathic pain; however, there seems to be a lack of consensus on the appropriate
treatment and strategies for these disorders. Themajor difference of SCES for visceral pain,
compared to postlaminectomy syndrome or to regional complex syndrome, is the number
of stimulated dermatomes. In most viscera, the somatotopic arrangement has two to four
medullar levels, sometimes requiring laterality. After reviewing the literature, we have
concluded that SCES is now a viable, low-risk option with satisfactory results for the
treatment of neuropathic and visceral pain; therefore, it can be used in refractory angina
after the failure of standard therapy. However, further studies are required to increase the
application and efficacy of this procedure in the clinical practice.