CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2019; 38(04): 272-278
DOI: 10.1055/s-0036-1594256
Review Article | Artigo de Revisão
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Spinal Cord Electrical Stimulation for Refractory Angina Treatment

Estimulação elétrica da medula espinal no tratamento da angina refratária
1   Pain Ambulatory, Hospital da Santa Casa de Montes Claros e Hospital Dilson Godinho, Montes Claros, MG, Brazil
2   Department of Atalgic Therapy, Functional Surgery, and Palliative Care, Escola de Cancerologia Celestino Bourroul da Fundação Antônio Prudente, São Paulo, SP, Brazil
2   Department of Atalgic Therapy, Functional Surgery, and Palliative Care, Escola de Cancerologia Celestino Bourroul da Fundação Antônio Prudente, São Paulo, SP, Brazil
3   Higher Council, Sociedade Brasileira para o Estudo da Dor, São Paulo, SP, Brazil
› Author Affiliations
Further Information

Publication History

13 June 2016

30 August 2016

Publication Date:
27 January 2017 (online)


Cardiovascular disease (CVD) is the main cause of death worldwide, including in Brazil. Angina pectoris is a challenging disease because its clinical manifestation is not always related to the degree of obstruction. Visceral pain from any source can be totally disabling. It influences all aspects of the life of a patient and it can be one of the main causes of absence from work and of family disruption. Spinal cord electrical stimulation (SCES) has been traditionally applied for the treatment of neuropathic pain, with good to excellent results. Visceral pain syndrome can be as debilitating and disabling as somatic or neuropathic pain; however, there seems to be a lack of consensus on the appropriate treatment and strategies for these disorders. The major difference of SCES for visceral pain, compared to postlaminectomy syndrome or to regional complex syndrome, is the number of stimulated dermatomes. In most viscera, the somatotopic arrangement has two to four medullar levels, sometimes requiring laterality. After reviewing the literature, we have concluded that SCES is now a viable, low-risk option with satisfactory results for the treatment of neuropathic and visceral pain; therefore, it can be used in refractory angina after the failure of standard therapy. However, further studies are required to increase the application and efficacy of this procedure in the clinical practice.


A doença cardiovascular (DCV) é a principal causa de morte em todo o mundo, inclusive no Brasil. A angina do peito permanece como entidade clínica desafiadora devido ao fato de sua manifestação clínica nem sempre estar relacionada com o grau de obstrução. A dor visceral de qualquer origem pode ser totalmente incapacitante. Ela influencia todos os aspectos da vida de um paciente, podendo ser uma das principais causas de interrupção das atividades laborais e da estrutura familiar. A estimulação elétrica da medula espinal (EEME) tem sido tradicionalmente aplicada para o tratamento de dor neuropática apresentando de bons a excelentes resultados. A síndrome de dor visceral pode ser tão debilitante e incapacitante quanto as dores somáticas ou neuropáticas; no entanto, parece haver uma falta de consenso sobre o tratamento adequado e as estratégias para estes transtornos. A grande diferença na estimulação medular para a dor visceral, em comparação com a síndrome pós-laminectomia ou com a síndrome complexa regional, é o número de dermátomos a serem estimulados. A grande maioria das vísceras tem somatotopia de dois a quatro níveis medulares, algumas das vezes necessitando de lateralidade. Após uma revisão da literatura, conclui-se que a EEME é hoje uma opção viável, de baixo risco e com resultados satisfatórios para o tratamento de dores de origem neuropática e visceral, portanto, passível de utilização na angina refratária, sendo indicada após a falha da terapia padrão. Porém, ainda há necessidade de mais estudos para maior empregabilidade e eficácia do procedimento na prática clínica.

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