Spinal Cord Stimulation Therapy for Patients With Refractory Angina Who Are Not Candidates for Revascularization

Zipes, Douglas P.; Svorkdal, Nelson; Berman, Daniel S.; Boortz-Marx, Richard L.; Henry, Timothy D.; Lerman, Amir; Ross, Edgar L.; Turner, Michael; Irwin, Christopher

doi:10.1111/j.1525-1403.2012.00452.x

Cited by 60 publications

(61 citation statements)

References 16 publications

(23 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…23,36 This did not hold true when comparing SCS to surgical intervention or SCS-based controls; however, SCS did provide both comparable analgesia (2B−) and similar functional outcomes (2B−) when compared with PMLR, 37 CABG, 34 subthreshold stimulation, 23,36 and minimally active controls. 38 Similarly, an analgesic-sparing effect (decreased quantity or frequency of nitrate rescue) is evident when compared with conventional medical management (1A+) and placebo-SCS (1A+), but this effect was not statistically significant when compared with CABG controls (2B−) 34 or minimally active SCS as a control (2B−). 38 This apparent divergence in efficacy of SCS may be the direct result of the control to which it is being compared.…”

Section: Discussionmentioning

confidence: 99%

“…34,35,37,38 This discordance in pain-related outcomes appears to be significantly affected by the choice of control incorporated into the study design (active control vs placebo or conventional medical management, Table 4). Spinal cord stimulation provided superior analgesia (1A+) for anginal pain when compared with conventional medical management or placebo-SCS (Table 4) and comparable analgesia (2B−) when compared with coronary artery bypass graft (CABG), 34 percutaneous myocardial laser revascularization (PMLR), 37 or minimally active SCS 38 and showed mixed results (2B±) when patients were randomized to have their SCS device turned on or off 35,39 or when compared with subthreshold active stimulation. 23,36 In Lanza and colleagues' 39 study of SCS for CXS patients, all patients had the intervention, and patients were randomized to comparisons during periods of stimulation being turned on or off.…”

Section: Perceived Pain Relief or Change In Pain Scorementioning

confidence: 99%

“…1A+ evidence was available comparing active SCS to placebo-SCS, with supporting 1B+ level of evidence when comparing SCS in the on versus off state (Table 4), but this positive evidence is contrasted by non-statistically different qualityof-life outcomes (2B−) when comparing SCS to CABG 34 and minimally active SCS. 38 Mixed results (2B±) were found when comparing SCS to conventional medical management or subthreshold SCS stimulation ( Table 4).…”

Section: Quality Of Lifementioning

confidence: 99%

See 2 more Smart Citations

Spinal Cord Stimulation 50 Years Later

Mekhail

Visnjevac

Azer

et al. 2018

Regional Anesthesia and Pain Medicine

View full text Add to dashboard Cite

To assess the efficacy of spinal cord stimulation (SCS) for each indication, one must critically assess each specific clinical outcome to identify outcomes that benefit from SCS therapy. To date, a comprehensive review of clinically relevant outcome-specific evidence regarding SCS has not been published. We aimed to assess all randomized controlled trials from the world literature for the purpose of evaluating the clinical outcome-specific efficacy of SCS for the following outcomes: perceived pain relief or change pain score, quality of life, functional status, psychological impact, analgesic medication utilization, patient satisfaction, and health care cost and utilization. Interventions were SCS, without limitation to the type of controls or the type of SCS in the active arms. For each study analyzed, a quality assessment was performed using a validated scale that assesses reporting, external validity, bias, confounding, and power. Each outcome was assessed specific to its indication, and the primary measure of each abovementioned outcome was a summary of the level of evidence. Twenty-one randomized controlled trials were analyzed (7 for trunk and limb pain, inclusive of failed back surgery syndrome; 8 for refractory angina pectoris; 1 for cardiac X syndrome; 3 for critical limb ischemia; 2 for complex regional pain syndrome; and 2 for painful diabetic neuropathy). Evidence assessments for each outcome for each indication were depicted in tabular format. Outcome-specific evidence scores were established for each of the abovementioned indications, providing both physicians and patients with a summary of evidence to assist in choosing the optimal evidence-based intervention. The evidence presented herein has broad applicability as it encompasses a breadth of patient populations, variations of SCS therapy, and comparable controls that, together, reflect comprehensive clinical decision making.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Perceived Pain Relief or Change In Pain Scorementioning

confidence: 99%

Section: Quality Of Lifementioning

confidence: 99%

See 1 more Smart Citation

Spinal Cord Stimulation 50 Years Later

Mekhail

Visnjevac

Azer

et al. 2018

Regional Anesthesia and Pain Medicine

View full text Add to dashboard Cite

show abstract

“…However, patients in both groups experienced reduction in the incidence of angina attacks and reported improved exercise tolerance. This study was terminated early due to difficulties with enrollment and also was underpowered for the primary outcome 43 . Two studies compared SCS with another active treatment modality.…”

Section: Results Of Randomized Controlled Trialsmentioning

confidence: 99%

Interventional treatment of pain in refractory angina. A review

Dobias¹,

Michálek²,

Neužil³

et al. 2014

BIOMED PAP

View full text Add to dashboard Cite

Background. Refractory angina is characterized by repeated attacks of chest pain in patients on maximal anti-anginal pharmacotherapy, with a professional conscensus that further surgical or radiological revascularization would be futile. Refractory angina is a serious but relatively uncommon health problem, with a reported incidence of approximately 30 patients per million people/year. In this condition simply treating the associated pain alone is important as this can improve exercise tolerance and quality of life.Methods. An extensive literature search using five different medical databases was performed and from this, eightythree papers were considered appropriate to include within this review. Results and Conclusion. Available literature highlights several methods of interventional pain treatment, including spinal cord stimulation and video-assisted upper thoracic sympathectomy which can provide good analgesia whilst improving physical activities and quality of life. The positive effect of spinal cord stimulation on the intensity of pain and quality of life has been confirmed in nine randomized controlled trials. Other potential treatment methods include stellate ganglion blocks, insertion of thoracic epidural or spinal catheters and transcutaneous electrical nerve stimulation. These approaches however appear more useful for diagnostic purposes and perhaps as short-term treatment measures.

show abstract

“…1 It was not until the 1960s that gate control theory 2 motivated Shealy and coworkers to use spinal cord stimulation (SCS) to treat pain. [3][4][5] Since then, the primary focus of research surrounding SCS has been based on electrical disruption of pain signals, 2 despite the fact that pain pathways involve both electrical and molecular mechanisms. [6][7][8][9][10][11][12][13][14][15][16][17][18][19] Although nociceptive signals are propagated along axons and dendrites via action potentials, calcium influx at the soma initiates cascade pathways resulting in glial cell activation as well as release of inflammatory mediators that sensitize neurons.…”

mentioning

confidence: 99%