Abstract
Refractory angina pectoris is a chronic desease characterized by the presence of angina caused by coronary insufficiency in the presence of coronary artery disease which cannot be controlled by a combination of medical therapy, angioplasty and coronary bypass surgery. Several methods of interventional pain treatment, especially spinal cord stimulation, can provide good analgesia with 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 the randomized controlled trials. Other potential treatment methods include upper thoracic sympathectomy, stellate ganglion blocks, insertion of thoracic epidural or spinal catheters, transcutaneous electrical nerve stimulation or peripheral subcutaneous field stimulation.
Education of the refractory angina pectoris patient is the cornerstone of individualized cardiac rehabilitation. Psychological support should be provided, if needed combined with the use of antidepressive drug treatment and a structured pain management programme.
Results published in the international literature and our own experience clearly confiry, that this symptomatic treatment helps to relieve attacks of pain and improves patient quality of life in a highly selected patient group.