Long-term home treatment with epidural analgesia does not affect later spinal cord stimulation in patients with otherwise intractable angina pectoris

Abstract

Objective: The only way some patients with retractable angina pectoris can endure the daily pain is by using opiates. Epidural morphine or spinal cord stimulation (SCS) for outpatients 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. Design: A prospective, nonrandomized study with a 4-year follow-up period. Setting: Department of Anaesthesia, Pain Section. A referral center in institutional practice. Ambulatory care. Patients: The 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. Intervention: SCS with epidural electrodes stimulating paresthesia in the area where angina is perceived. Main Outcome Measure: Difference for the patients previously treated with epidural catheters in stimulation amplitude, frequency of electrode migration, and effect of SCS. Results: Stimulation 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). Conclusions: SCS in patients previously treated with epidural catheters has an effect equal to that in other patients.