The sustained benefits of long-term neurostimulation in patients with refractory chest pain and normal coronary arteries

Objectives: To assess the long-term efficacy of neurostimulation for treating refractory angina pectoris-like chest pain, we followed patients, treated with either transcutaneous electrical nerve stimulation (TENS) or spinal cord stimulation (SCS). Methods: Neurostimulation was judged successful and subsequently continued when initial pain was reduced at least 50%. All patients started with TENS, but if skin irritation occurred during TENS, a SCS system was implanted. The quality of life was measured at baseline and follow-up with the Seattle Angina Questionnaire. Additional information was gathered concerning anti-anginal medication, complaints, and physical condition. Results: Of 36 patients treated successfully with neurostimulation, we identified 24 patients after a mean (SD) follow-up period of 5.08 (3.86) years; 12 patients dropped out of the study. In 13 of the remaining 24 patients, TENS induced skin irritation. Eight of these 13 patients received successful SCS, while five refused implantation. In the 24 patients, a mean pain reduction of 57% was achieved in conjunction with an increased exercise capacity of 30% and walking distance increased from 0.73 (0.83) to 1.62 (1.62) (p = 0.018). Within the Seattle Angina Questionnaire the domain 'disease perception' improved from 38.89 (16.61) to 49.31 (21.83) (p = 0.004), the domain 'physical limitation' improved from 29.89 (15.10) to 40.97 (22.63) (P = 0.001) and 'anginal frequency' improved from 41.67 (24.08) to 55.00 (23.03) (p = 0.005). In addition, nitroglycerin consumption was reduced from 7.85 (8.49) to 1.98 (2.19) (p = 0.001). Conclusion: Neuro stimulation techniques should thus be of widespread value for treating angina pectoris-like chest pain in patients who are refractory to medication. (c) 2006 European Federation of Chapters of the International Association for the Study of Pain. Published by Elsevier Ltd. All rights reserved.