Spinal cord stimulation in the treatment of refractory angina: systematic review and meta-analysis of randomised controlled trials

Taylor, Rod S; Vries, Jessica de; Buchser, Eric; DeJongste, Mike J. L.

doi:10.1186/1471-2261-9-13

Cited by 123 publications

(91 citation statements)

References 30 publications

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“…With appropriately selected patients at centers with interdisciplinary expertise, the trial-to-implant conversion rates can be quite encouraging: in the 65%-80% range for various diagnoses, 15 although from a nationwide perspective, the actual conversion rate remains less encouraging at approximately 41%. 7 The utility of this technology has been demonstrated in prospective randomized and observational studies, and in systematic literature reviews for various pathologies, including PPNP after structurally corrective lumbar spinal surgery, 6 complex regional pain syndrome, 27 chronic inoperable limb ischemia, 31 treatment-refractory angina, 28 and painful diabetic neuropathy. 3 Despite its proven efficacy for the PPNP population, there have been a few small studies that reported on the risk experienced by patients undergoing such intervention specifically in the context of managing neuropathic pain after lumbar spinal surgery, and whether those rates of complication are variable by surgical technique.…”

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confidence: 99%

Complications related to the use of spinal cord stimulation for managing persistent postoperative neuropathic pain after lumbar spinal surgery

Shamji

Westwick

Heary

2015

FOC

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OBJECT Structural spinal surgery yields improvement in pain and disability for selected patients with spinal stenosis, spondylolisthesis, or a herniated intervertebral disc. A significant fraction of patients exhibit persistent postoperative neuropathic pain (PPNP) despite technically appropriate intervention, and such patients can benefit from spinal cord stimulation (SCS) to alleviate suffering. The complication profile of this therapy has not been systematically assessed and, thus, was the goal of this review. METHODS A comprehensive literature search was performed to identify prospective cohorts of patients who had PPNP following structurally corrective lumbar spinal surgery and who underwent SCS device implantation. Data about study design, technique of SCS lead introduction, and complications encountered were collected and analyzed. Comparisons of complication incidence were performed between percutaneously and surgically implanted systems, with the level of significance set at 0.05. RESULTS Review of 11 studies involving 542 patients formed the basis of this work: 2 randomized controlled trials and 9 prospective cohorts. Percutaneous implants were used in 4 studies and surgical implants were used in 4 studies; in the remainder, the types were undefined. Lead migration occurred in 12% of cases, pain at the site of the implantable pulse generator occurred in 9% of cases, and wound-related complications occurred in 5% of cases; the latter 2 occurred more frequently among surgically implanted devices. CONCLUSIONS Spinal cord stimulation can provide for improved pain and suffering and for decreased narcotic medication use among patients with PPNP after lumbar spinal surgery. This study reviewed the prospective studies forming the evidence base for this therapy, to summarize the complications encountered and, thus, best inform patients and clinicians considering its use. There is a significant rate of minor complications, many of which require further surgical intervention to manage, including lead migration or implant infection, although such complications do not directly threaten patient life or function.

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confidence: 99%

Complications related to the use of spinal cord stimulation for managing persistent postoperative neuropathic pain after lumbar spinal surgery

Shamji

Westwick

Heary

2015

FOC

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“…The authors did not demonstrate any difference in terms of exercise tolerance or overall quality of life between the groups. A meta-analysis of published studies has reported reduced angina attacks in SCS patients from 5.5 to 2.2 within 48 hours 35 . The ongoing multicenter RASCAL study aims to compare the efficacy and cost-effectiveness of SCS versus standard care in patients with the refractory angina 46 .…”

Section: Results Of Randomized Controlled Trialsmentioning

confidence: 99%

“…They must be a part of multidisciplinary treatment plan involving effective pharmacotherapy, physiotherapy, cognitive-behavioral therapy and pain interventions. There is a clear evidence supporting the use of spinal cord stimulation in patients with chronic pain of cardiac origin including refractory angina 35,80,83 . Treatment modalities involving the interruption of upper thoracic sympathetic chain or subcutaneous target field stimulation are promising but need further confirmation in the setting of a randomized controlled trial (Table 2).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, stimulation causes a sensation of vibration which may be pleasant for some patients 35 . The total number of patients treated worldwide with the SCS for RAP is estimated to be as high as 3500.…”

Section: Spinal Cord Stimulation (Scs)mentioning

confidence: 99%

“…The method of action is not explicitly understood but several theories have been postulated. These theories include a gate-control theory, theories of direct release of beta-endorphines and homogenization of myocardial perfusion via an adenosine activation and reduction in "steal phenomenon" [33][34][35] . Initial studies regarding SCS in refractory angina were published in the 1980s 36,37 .…”

Section: Spinal Cord Stimulation (Scs)mentioning

confidence: 99%

See 2 more Smart Citations

Interventional treatment of pain in refractory angina. A review

Dobias¹,

Michálek²,

Neužil³

et al. 2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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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.

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Acupuncture for angina pectoris

Kim

Lee

Kim

et al. 2011

Cochrane Database of Systematic Reviews

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Spinal cord stimulation in the treatment of refractory angina: systematic review and meta-analysis of randomised controlled trials

Abstract: Background: The aim of this paper was undertake a systematic review and meta-analysis of the use of spinal cord stimulation (SCS) in the management of refractory angina.

Cited by 123 publications

References 30 publications

Complications related to the use of spinal cord stimulation for managing persistent postoperative neuropathic pain after lumbar spinal surgery

Complications related to the use of spinal cord stimulation for managing persistent postoperative neuropathic pain after lumbar spinal surgery

Interventional treatment of pain in refractory angina. A review

Acupuncture for angina pectoris

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