• C Andersen and P Hole.
• Department of Cardiothoracic Anaesthesia, Odense University Hospital, Denmark.
• Clin J Pain. 1998 Dec 1;14(4):315-9.

ObjectiveThe only way some patients with intractable angina pectoris can endure the daily pain is by using opiates. Epidural morphine or spinal cord stimulation (SCS) for out-patients is a possibility for this patient group. The aim of this study was to determine whether patients previously treated with epidural injections had more frequent electrode migration, higher stimulation needs, and less effect of SCS treatment.DesignA prospective, nonrandomized study with a 4-year follow-up period.SettingDepartment of Anaesthesia, Pain Section. A referral center in institutional practice. Ambulatory care.PatientsThe patient group comprised 53 patients; all had been treated daily with opiates. A total of 26 patients had epidural catheters for a mean time of 1 year before SCS. All patients had intractable angina pectoris. For these patients, further angioplasty or coronary bypass surgery was not technically possible. Even with maximal medication, it was impossible to cope with the patients' angina pectoris, and the only way the patients could endure the daily pain was by using opiates. Therefore, alternative therapies were considered to give these patients palliation.InterventionSCS with epidural electrodes stimulating paresthesia in the area where angina is perceived.Main Outcome MeasureDifference for the patients previously treated with epidural catheters in stimulation amplitude, frequency of electrode migration, and effect of SCS.ResultsStimulation demand (p = 0.09), frequency of electrode migrations (p = 0.46), and pain-reducing effect (p = 0.16) were not different for the group of patients previously treated with epidural catheters for longer periods (1-36 months).ConclusionsSCS in patients previously treated with epidural catheters has an effect equal to that in other patients.

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