An evidence-based review of neuromodulation for the treatment and management of refractory angina

Urits, Ivan; Patel, Arpan; Leider, Joseph; Anya, Anthony; Franscioni, Henry; Jung, Jai Won; Kassem, Hisham; Kaye, Alan D.; Viswanath, Omar

doi:10.1016/j.bpa.2020.08.006

Cited by 2 publications

(4 citation statements)

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“…This reduction in sympathetic tone leads to a decrease in oxygen demand in the myocardium, consequently resulting in anti-ischemic effects ( 8 , 17 , 21 ). In addition, a potent endogenous vasodilator known as calcitonin gene-related peptide (CGRP) was also demonstrated to be upregulated by SCS ( 8 , 18 , 19 ). The release of CGRP triggers the release of nitric oxide (NO), resulting in vascular smooth muscle relaxation, vasodilation, and a reduction of vasospasms, all contributing to the anti-ischemic effect of SCS ( 8 , 18 , 19 ).…”

Section: Literature Reviewmentioning

confidence: 99%

“…In addition, a potent endogenous vasodilator known as calcitonin gene-related peptide (CGRP) was also demonstrated to be upregulated by SCS ( 8 , 18 , 19 ). The release of CGRP triggers the release of nitric oxide (NO), resulting in vascular smooth muscle relaxation, vasodilation, and a reduction of vasospasms, all contributing to the anti-ischemic effect of SCS ( 8 , 18 , 19 ). Croom et al discovered that CGRP antagonists inhibited SCS-induced skin vasodilation in rats, clarifying the relationship between SCS and CGRP release ( 23 ).…”

Section: Literature Reviewmentioning

confidence: 99%

“…This finding implies that CGRP could be responsible for the clinical improvement of ischemic conditions following SCS ( 23 ). Thus, the reduction of sympathetic tone, consequently decreasing oxygen demand of the myocardium, in conjunction with CGRP and NO-induced vasodilation, appears to be the primary contributor to the anti-ischemic effect of SCS ( 8 , 18 , 21 ). The resulting effect is an increase in myocardial perfusion and a reduction of anginal pain ( 8 , 18 , 21 ).…”

Section: Literature Reviewmentioning

confidence: 99%

“…People with this condition experience daily pain and typically have a reduced quality of life, emphasizing the value of SCS introduction to alleviate pain in patients living with RFA despite maximal medical therapy (17). Indications for SCS include (1) patients living with severe refractory angina pectoris who are ineligible for coronary revascularization surgery due to risks of surgical complications and (2) patients who do not respond to standard treatments for RFA, which can vary across different centers (17)(18)(19). Contraindications of SCS include but are not limited to spinal cord disorders, coagulopathy, local infection, sepsis, cognitive impairment causing an inability to handle and understand the usage of the device, and psychiatric conditions such as psychosis, schizophrenia, substance abuse, and severe depression or anxiety (16,20).…”

Section: Literature Review 31 Physiological Mechanism Of Scs In Refra...mentioning

confidence: 99%

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Spinal cord stimulation for refractory pericarditis: a case report and a review of the mechanism of action

Elsliger,

Saucier,

Schneider

et al. 2023

Front. Pain Res.

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Background and objectivesIn recent years, spinal cord stimulation (SCS) has emerged as a promising management option for chronic pain of multiple etiologies. While its effectiveness has been strongly suggested in many patients, the exact mechanism of action of SCS is incompletely understood. This article reviews the leading mechanisms underlying the analgesic and cardiovascular effects of SCS and reports its novel benefits in a case of recurrent pericarditis.Literature reviewThroughout history, the analgesic properties of SCS were thought to arise via stimulation of the spinothalamic tract. Although this mechanism has been thoroughly reported, new research and patient outcomes from SCS have revealed various additional properties that cannot be fully explained by this mechanism alone. Evidence suggests that SCS enhances calcitonin gene-related peptide release and modulates inflammatory cytokine secretion, sympathetic tone, and inhibitory neurotransmitter secretion. These distinct mechanisms likely collectively contribute to the therapeutic effects of SCS on the cardiovascular system and pain management.Case reportWe report the case of a 48-year-old male patient with recurrent pericarditis, characterized by refractory angina-like pain and reduced left ventricular ejection fraction (LVEF). After 1 year of having a spinal cord stimulator implanted, the patient is free from pain and narcotics, with a reduction of 428 mg equivalent dose of morphine. The patient's LVEF increased from 40% to 45% without changes to his previous medical treatment. This is the first reported case of refractory pericarditis managed with spinal cord stimulation.ConclusionRecognizing the improved pain management, reduced narcotic usage, and improved LVEF in our patient following SCS is critical to paving the way toward a complete understanding of the mechanism of action of SCS. This case reveals the therapeutic potential of SCS for cardiovascular pathologies other than refractory angina pectoris.

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