Spinal-cord stimulation for angina pectoris and peripheral vascular disease

Michael Erdek, Peter S. Staats

Research output: Contribution to journalArticle

Abstract

SCS is a viable option for treating angina pectoris and inoperable PVD. Its mechanism of action remains controversial, but successful pain relief has been consistently reported in various studies. Many clinicians are foregoing a formal trial, choosing instead to obtain an adequate area of paresthesia and implant in one session. Long-term follow-up of SCS patients treated for angina pectoris shows continued pain relief, increase in activities, and decreased use of medications. Emerging literature supports the finding that SCS is cost-effective in this patient population relative to CABG. SCS does not mask the ischemic pain that signals impending further damage of the myocardium. In patients with inoperable PVD, SCS relieves pain and improves microcirculatory blood flow. Quality of life and mobility can be improved with SCS. The beneficial effects of SCS on ulcer healing are controversial, and evidence suggests that the best candidates for the procedure are those with ischemic rest pain without tissue loss. Patients with diabetes mellitus and hypertension may have the least favorable outcomes with regard to limb salvage. No convincing data have been published on the cost-effectiveness of SCS in this patient population. SCS is a safe procedure that is minimally invasive, reversible, and associated with only infrequent side effects, the most common of which include lead migration and infection. SCS is clearly an option for the improvement of pain and the quality of life in this carefully selected subset of patients.

Original languageEnglish (US)
Pages (from-to)797-804
Number of pages8
JournalAnesthesiology Clinics of North America
Volume21
Issue number4
DOIs
StatePublished - Dec 2003

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Spinal Cord Stimulation
Peripheral Vascular Diseases
Angina Pectoris
Pain
Quality of Life
Nociceptive Pain
Limb Salvage
Paresthesia
Masks
Population
Ulcer
Cost-Benefit Analysis
Myocardium
Diabetes Mellitus
Hypertension
Costs and Cost Analysis
Infection

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Spinal-cord stimulation for angina pectoris and peripheral vascular disease. / Erdek, Michael; Staats, Peter S.

In: Anesthesiology Clinics of North America, Vol. 21, No. 4, 12.2003, p. 797-804.

Research output: Contribution to journalArticle

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