FAQs on Spinal Cord Stimulator Implant for Refractory Angina Pectoris

30 Dec FAQs on Spinal Cord Stimulator Implant for Refractory Angina Pectoris

The anti-anginal and anti-ischemic benefits of spinal cord stimulation also extend to the treatment of refractory angina pectoris. Its long-term efficacy, safety, and improved survival rates are echoed by various studies.

What is refractory angina pectoris?

Refractory angina pectoris occurs when chronic chest pain caused by reduced blood supply to the heart unresponsive to medical treatment, including revascularization. It is angina pectoris resistant to any type of conventional therapies.

What are symptoms of refractory angina pectoris?

• Recurring chest pain and discomfort not relieved by any type of medical treatment
• No angiogenesis
• Chronic unstable angina

What causes refractory angina pectoris?

Refractory angina pectoris is caused by long-running angina pectoris symptoms. Growing stenosis of blood vessels reduces blood and oxugen supply. Chronic paucity of oxygen stimulates mechanoreceptive receptors in the heart. These activated receptors release certain chemicals that stir sensory ends of afferent nerve fibers. As a result, patients become resistant to angina treatment and experience pain.

How does spinal cord stimulation treat refractory angina pectoris?

Spinal cord stimulation helps refractory angina pectoris patients by

• Interfering with pain transmission and inhibiting pain perception
• Reducing the need for myocardial oxygen
• Improving blood flow to the heart
• Preventing increase in sympathetic tone
• Altering functions of afferent nerve fibers and preventing too much release of amino acids
• Enhanced beta-endorphin release that reduces pain

How effective is spinal cord stimulation in reducing pain associated with refractory angina pectoris?

Studies attest the benefits of spinal cord stimulation for patients with refractory angina pectoris, such as pain relief, prevention of ischemic events, improved blood supply, better survival rates, and improved quality of life and functional ability. Korean researchers found SCS therapy a effective way to manage chest pain linked to refractory angina pectoris.

According to a 2009 meta-analysis, spinal cord stimulation offers benefits similar to coronary artery bypass grafting and percutaneous myocardial laser revascularization at lower cost and with marked improvements and significant gains for patients.

How is a spinal cord stimulator implant done?

The spinal cord implant is a two-stage process – first a trial test and then the permanent implant.

During the trial, refractory angina pectoris patients carry an external spinal cord stimulator. It is connected to electrode leads through a wire. Electrode leads are inserted into epidural space using local anesthesia. The trial continues for a week and if at least 50% refractory angina pectoris pain relief is achieved, a permanent SCS implant is recommended.

The permanent implant is performed using general anesthesia. An incision is made to put electrode leads close to the spinal cord. Another incision just above the buttock allows to implant the device. Both are connected through a wire that remains hidden under soft tissues. Incisions are closed after a test run.

What can I expect after the implant procedure?

Expect to have mild discomfort and soreness for a few days. There may be swelling at the incision site. You will be discharged after a few hours.

Patients are barred from working for a week and driving for four weeks. They are also advised not to do rigorous activities, running, and swimming for six weeks. Avoid raising hand over the head, twisting, bending, and weight lifting for six weeks.

How is the neuromodulator controlled?

The implanted spinal cord stimulator is controlled using a hand-held remote device that can be carried in your pocket or purse. Patients using it for refractory angina pectoris pain relief can operate, reset, and program the stimulator using this remote device.

When should I expect pain relief?

Patients experience relief from refractory angina pectoris pain as soon as the spinal cord stimulator implant is done. However, the initial pain relief is not stable. The actual level of relief they will have in the long-term becomes visible after 72 hours.

Do I need to replace the spinal cord stimulator in future?

The implant is a life-time procedure. However, you have to change the battery of the device in 5 to 10 years depending on the usage.

Do I need to stay in the hospital after the implant?

No, spinal cord stimulator implant is an outpatient procedure.

Is there any threat to the spinal cord due to the device?

It is safe to have spinal cord stimulator implant in your body. Spinal cord stimulation to manage refractory angina pectoris pain does not pose any threat to the spine. However, the implant surgery unless performed by an expert may cause injuries.

Does the spinal cord stimulator make any noise?

No, it does not make any sound. All that you can feel is mild sensation when it is on.

Is the process covered by insurance?

Many insurance providers offer plans covering spinal cord stimulator implant to manage refractory angina pectoris pain.

What are risks associated with spinal cord stimulation therapy?

• No general side effects in refractory angina pectoris patients
• Surgical complications may be there following spinal cord stimulator implant
• Spinal headache in patients with spinal fluid leakage
• Revision surgery following scar tissue formation

Resources

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

Taylor RS, De Vries J, Buchser E, et al. Spinal cord stimulation in the treatment of refractory angina: systematic review and meta-analysis of randomized controlled trials. BMC Cardiovasc Disord. 2009;9:13.

Romano M, Auriti A, Cazzin R, et al. The spinal cord stimulation as a treatment of refractory angina pectoris. Long-term clinical effectiveness, complications and mortality. An Italian multicenter study. Italian heart journal. February 2000; 1(1):97-102.

Eddicks S, Maier-Hauff K, Schenk M, Müller A, Baumann G, Theres H. Thoracic spinal cord stimulation improves functional status and relieves symptoms in patients with refractory angina pectoris: the first placebo-controlled randomised study. Heart. 2007; 93:585–590.