Subcutaneous Target Stimulation–Peripheral Subcutaneous Field Stimulation in the Treatment of Refractory Angina: Preliminary Case Reports

Abstract

Spinal cord stimulation is now established as an effective treatment for refractory angina. We present the use of an alternative approach to neuromodulation of anginal pain using subcutaneous leads placed at the site of pain. In this case series, five patients with refractory angina received successful treatment with subcutaneous target stimulation-peripheral subcutaneous field stimulation. This technique was able to provide good analgesia in two patients that had had poor pain relief from existing spinal cord stimulators. All five patients achieved significant pain relief with a reduction in symptoms and a decrease in the use of pain medication.

Chronic Poststernotomy Pain

“…55 Invasive procedures include neuraxial injections of steroids, opioids, or other relaxants; the placement of spinal cord stimulators; and direct nerve blocks in which local anesthetic, chemical neurolysis, or radiofrequency ablation is used. [56][57][58][59][60][61][62] While each of these treatments has been used to treat chronic pain, the evidence to support their use following sternotomy is largely anecdotal.…”

“…78 Similarly, pregabalin reduced postoperative opioid consumption, the incidence of confusion on the first postoperative day, and decreased pain with movement 3 months postoperatively. [59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78] Ketamine Ketamine interacts with opioid receptors, monoaminergic receptors, muscarinic receptors, voltage-sensitive calcium channels, and most importantly as a noncompetitive antagonist of NMDA receptors. Ketamine has documented efficacy in the treatment of acute postoperative pain, as well as prevention and treatment of chronic pain syndromes.…”

Interventional treatment of pain in refractory angina. A review

“…Patients also experienced improved quality of life and increased exercise tolerance 61 . Another case report describes a series of five patients in whom SENS/PSFS provided good pain relief, improvement of symptoms and reduction in pharmacotherapy 62 . Two of these patients had analgesic effect with subcutaneous stimulation where previous SCS had failed.…”

“…The region affected by chest pain should be completely covered during stimulation. SENS (or peripheral subcutaneous field stimulation -PSFS) is a technically simple method, which is not associated with the potentially serious complications associated with SCS but this technique requires further evaluation 61,62 . The method has been more extensively studied in patients with low back pain and several mechanisms of action have been proposed.…”

Electrical Neuromodulation and the Heart with Special Emphasis on Myocardial Ischemia

“…This method seems to be effective in the treatment of patients with therapeutically refractory angina. 52,53 Patients with severe coronary artery disease, in which withholding anti-thrombotic pharmacotherapeutics is not feasible, may be excellent candidates for both subcutaneously implanted device and leads. Other drawbacks of the SCS treatment are that electrode placement into the epidural space is rather critical when compared to epidural placement.…”