Aims Spinal cord stimulation (SCS) is a treatment for patients with refractory angina pectoris (RAP) who remain symptomatic despite optimal medical therapy and without revascularisation options. Previous studies have shown that SCS improves the quality of life in this patient group and reduces the severity of the angina pectoris. The aim of this prospective, singlearm observational study is to show this effect in a single-centre cohort using a multidisciplinary team approach to the selection process, with a follow-up period of 1 year. Methods and results Between July 2010 and March 2017, 87 patients with RAP referred to our centre received SCS. The Seattle Angina Questionnaire (SAQ) and RAND 36-Item Health Survey (RAND-36) were completed at baseline, prior to implantation, and 1 year post-implantation. After 1 year of followup there was a statistically significant decrease in the frequency of angina pectoris attacks from more than 4 times a day to 1-2 times a week (p < 0.001). The SAQ showed statistically significant improvement in four of the five dimensions: physical limitation (p < 0.001), angina frequency (p < 0.001), angina stability (p < 0.001) and quality of life (p < 0.001). The RAND-36 showed statistically significant improvement in all Electronic supplementary material The online version of this article (
The number of patients with coronary artery disease (CAD) who have persisting angina pectoris despite optimal medical treatment known as refractory angina pectoris (RAP) is growing. Current estimates indicate that 5 to 10% of patients with stable CAD have RAP. In absolute numbers there are 50,000 to 100,000 new cases of RAP each year in the United States and 30,000 to 50,000 new cases each year in Europe. The term RAP was formulated in 2002. RAP is defined as a chronic disease (more than three months) characterized by diffuse coronary artery disease in the presence of proven ischemia which is not amendable to a combination of medical therapy, angioplasty or coronary bypass surgery.
There are currently few treatment options for patients with RAP. One such last-resort treatment option is spinal cord stimulation (SCS) with a Class of recommendation IIB, level of evidence B in the 2019 European Society of Cardiology Guidelines for the diagnosis and management of chronic coronary syndromes. The aim this review is to give an overview of neuromodulation as treatment modality for patients with RAP. A comprehensive overview is given on the history, proposed mechanism of action, safety, efficacy and current use of SCS.
Background: Chronic post-surgical pain is the main problem after inguinal hernia repair, frequently mandating treatment. Different treatment modalities are proposed. The aim of this review was to evaluate recent literature on different interventions to treat chronic inguinal pain after inguinal hernia repair and their outcomes.Methods: The Medline database, CINAHL, Embase, and Pubmed, including e-links to related articles, and the clinical trial registry of the Cochrane Collaboration were searched for relevant articles. Studies since 2001 reporting an intervention and their outcome to treat chronic postoperative inguinal pain in adult patients were selected. Study design, length of follow-up, number of included and evaluated patients, definition of chronic pain, description, as well as outcome of the intervention are extracted.Results: A total of 29 studies were included; eleven of them were prospective, the remaining retrospective. One study about pharmacological treatment (n ¼ 2), two studies about peripheral nerve blockage (n ¼ 9), three studies about pulsed radiofrequency (n ¼ 12), four studies about neurostimulation (n ¼ 7), one study about removal of staples or tackers (n ¼ 1), one study about neuroablation (n ¼ 10), and 17 studies about neurectomy (n ¼ 733) were included.Conclusions: This collective review shows the broad spectrum of interventions to treat chronic postoperative inguinal pain. Due to a wide range of pain definitions and outcome measurement a true comparison is difficult.
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