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Spinal cord stimulation to treat intractable chest pain related to angina pectoris was mentioned in 1987. Subsequent research reports published by acclaimed medical journals have highlighted significant benefits of the SCS procedure in reducing frequency of anginal episodes, decreasing ischemic pain, bettering exercise tolerance, enhancing myocardial blood flow, restoring functional ability of heart, and improving quality of life.

What is angina pectoris chest pain?

Angina pectoris refers to chest pain, pressure, or squeezing caused by ischemia or reduced blood supply to the heart. Coronary artery chest-paindisease chokes arteries feeding the heart and prevents adequate blood and oxygen supply to the heart. Reduced blood flow stirs cardio nerve endings and inhibiting the functioning of heart muscles. This leads to in strangling feeling or chest pain.

What are symptoms of angina pectoris chest pain?

  • Squeezing heart pain
  • Chest pain lasting for a brief period at a time
  • Pressure on heart as if a heavy weight placed on the heart
  • Chest discomfort
  • Pain radiating to neck, arms, back and shoulders
  • Chest pain following exercise or physical exertion
  • Breathlessness, sweating, and nausea may accompany pain

What causes angina pectoris?

  • Inadequate blood supply to heart
  • Stenosis, spasm, or blockage in arteries feeding the heart
  • Narrowing cardiac blood vessels
  • Severe anemia, reduced hemoglobin concentration due to long-term smoking
  • Prolonged diabetes, high cholesterol, high blood pressure
  • Persistent emotional stress

How effective is spinal cord stimulation for angina pectoris chest pain?

According to a 2001 study spinal cord stimulation helps angina pectoris patients in four ways – decrease in chest pain, lesser myocardial oxygen need, diminished sympathetic tone, and enhanced coronary microcirculatory blood flow.

A recent South Korean research claims therapeutic use of spinal cord stimulation helps reverse “severe symptoms and impaired activities of daily living” associated with angina pectoris. A 2007 study found that spinal cord stimulation “reduces angina pectoris frequency and intensity, and increases exercise capacity without masking the warning signs of a myocardial infarction.” It termed SCS therapy more effective than transcutaneous electrical nerve stimulation.

In 2010, the Heart journal made similar claims highlighting SCS implant benefits for angina pectoris chest pain.spinal-cord-stimulator-horizontal

Does spinal cord stimulator interact with pacemaker?

Spinal cord stimulator when used in strict bipolar right-ventricular sensing there will not be any interaction with pacemaker. Else, both devices may affect each other.

Does spinal cord stimulation offer greater benefits than surgical therapy?

Research findings attest clinical efficacy of SCS therapy in creating better anti-ischemic effect at lower cost than heart surgery and myocardial laser revascularization.

The American Journal of Cardiovascular Drugs published a study in 2009 showcasing that “spinal cord stimulation provides a relief from angina pectoris symptoms equivalent to that provided by surgical therapy, but with fewer complications and lower rehospitalization rates.” It also claimed that the therapy provided “not only a symptomatic improvement, but also a decrease in myocardial ischemia and an increase in coronary blood flow” and was easy to tolerate.

According a 2009 meta-analysis, spinal cord stimulation is “as effective and safe treatment option in the management of refractory angina patients as percutaneous myocardial laser revascularization.”

What is a spinal cord stimulator?

A spinal cord stimulator is an electrical device placed in the epidural space. It emits electric signals that create an electromagnetic sphere close the spine to hinder pain sensation-carrying nerve fibers. Obstruction of pain sensation transmission leads to their non-perception by the brain and it ensures pain relief.

How does spinal cord stimulation treat cardiac ischemic syndromes?

Inadequate blood and oxygen supply through choked constricted blood vessels activates the mechanoreceptive receptors of the heart. These receptors release certain chemicals that stir sensory ends of nerve fibers. This leads to angina pectoris chest pain.

Spinal cord stimulation counters angina pectoris chest pain in four ways. It decreases chest pain by obstructing pain signal transmission carrying nerve fibers. Electrical stimulation alters the functions of sensitive afferent nerve fibers. This leads to decline in the level of exitatory amino acids. As a result, there is less need for myocardial oxygen need and diminished sympathetic tone.

Spinal cord stimulation improves coronary microcirculatory blood flow and the release of beta-endorphin, which helps in decreasing pain perception.

Who is suitable to undergo spinal cord stimulator implant to treat angina pectoris chest pain?Spinal Cord Stimulator Trial

Anyone with good physical and mental health and suffering from severe angina pectoris chest pain can go for spinal cord stimulator implant. He or she should have been angina pectoris-linked chest pain for a longer period without significant relief from conservative and medical therapies.

How is a spinal cord stimulator implant procedure done?

The spinal cord stimulator implant is performed in two stages – the trial stage and the actual implant.

During the trial phase, the spinal cord stimulator is wrapped around the waist. A catheter using a needle insertion in the lumbar spine area connects to it. The device delivers electrical pulses through the catheter. If a patient suffering from angina pectoris chest pain has at least 50% pain relief during the trial, he or she is considered for permanent spinal cord stimulator implant.

The trial goes on for a week.

How is spinal cord stimulator implanted?

Spinal cord stimulator implant is performed using general anesthesia. An incision is made just above the buttock to place the device. Electrodes are placed close to the spinal column inside using another tiny incision. A small wire connects the device with electrodes traversing through soft tissues.

The spinal cord stimulator is programmed and switched on. The incisions are closed after a trial check.

How long does it take?

The spinal cord stimulator implant surgery takes about 2 to 3 hours.

What can I expect after the implant procedure?

Patients have bruising, soreness, and swelling for a few days. Pain relief is experienced immediately after the implant.

How is the spinal cord stimulator operated?

Spinal cord stimulator can be operated using an easy-to-carry remote device.

When should I expect pain relief?

Angina pectoris patients experience relief from intractable chest pain immediately after the implant. However, the actual pain relief that you are going to have for long-term is experienced only after three days.

What are post-surgical precautions?

  • Keep the incisions dry and clean
  • Take rest for 7 days
  • Avoid raising hands over your head or bathing in a tub for a week
  • Avoid pressure on the surgical site
  • No intense activity, twisting, or bending for 6 weeks
  • No driving for 4 weeks

Do I need to change spinal cord stimulator implant?

There is no need to change spinal cord stimulator for 15 to 20 years. You may need to change batteries of the device after 5 to 10 years.

There are spinal cord stimulators available with internal and external batteries.

What are risks associated with spinal cord stimulation therapy?

Spinal cord stimulation therapy is without any side effect. However, there may be complications associated with implant surgery. Spinal fluid leakage and scar tissue formation are reported in rare cases. Patients with SCS device may not be fit to undergo MRI tests.

Pain and Spine Clinics offers spinal cord stimulator for all types of conditions that cause chronic pain that is not amenable to surgery or has failed surgery. Most insurance is accepted with outcomes being tremendous. Call today!

References

Lee SH, Jeong HJ, Jeong SH, et al. (2012). Spinal Cord Stimulation for Refractory Angina Pectoris -A Case Report. Kor J Pain, 25(2), 121-125.

Eckert S, Horstkotte D. Management of angina pectoris: the role of spinal cord stimulation. Am J Cardiovasc Drugs. 2009;9(1):17-28.

De Vries J, De Jongste MJ, Spincemaille G, et al. Spinal cord stimulation for ischemic heart disease and peripheral vascular disease. Adv Tech Stand Neurosurg. 2007;32:63-89.

Taylor SR, De Vries J, Buchser E, et al. Spinal cord stimulation in the treatment of refractory angina: systematic review and meta-analysis of randomised controlled trials. BMC Cardiovascular Disorders 2009, 9:13

Latie OA, Nedeukovic S, Stevenson LW, Spinal Cord Stimulation for Chronic Intractable Angina Pectoris: A Unified Theory on Its Mechanism. Clin. Cardiol. 2001;24, 533-541

Andréll P, Yu W, Gersbach P, et al. Long-term effects of spinal cord stimulation on angina symptoms and quality of life in patients with refractory angina pectoris—results from the European Angina Registry Link Study (EARL). Heart 2010;96:1132-1136

Börjesson M, Andrell P, Lundberg D, Mannheimer C. Spinal cord stimulation in severe angina pectoris–a systematic review based on the Swedish Council on Technology assessment in health care report on long-standing pain. Pain. 2008;140:501–508.

de Jongste MJ, Hautvast RW, Hillege HL, Lie KI. Efficacy of spinal cord stimulation as adjuvant therapy for intractable angina pectoris: a prospective, randomized clinical study. Working Group on Neurocardiology. J Am Coll Cardiol. 1994;23:1592–1597.