Spinal Cord Electrical Stimulation for Refractory Angina Treatment

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 fromany 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. Themajor 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.

Sobrecrecimiento bacteriano como etiología de dolor cronico no oncológico visceral / Small bowel bacterial overgrowth a cause of visceral noncancer chronic pain

El dolor visceral crónico se produce por la distención de los receptores neuronales localizados en las mucosas de los distintos órganos del aparato digestivo, presentándose clínicamente como un dolor con una localización difusa, con intensidad moderada a severa, que se describe generalmente de tipo cólico. Presentamos un caso clínico de una paciente con que consultó por un dolor crónico no oncológico de tipo visceral con componente neuropático, cuya causa etiológica correspondió a sobrecrecimieno bacteriano intestinal. Por lo que debemos considerar esta patología como etiología de un dolor visceral crónico...

Chronic Visceral pain is caused by the distension of neuronal receptors located in the lining the digestive organs, clinically presenting as pain with a diffuse localization and moderate to severe intensity, usually is described colicky. We present a case report a patient who presented with chronic noncancer visceral pain with neuropathic component, which accounted etiology Small intestinal bacterial overgrowth. We must consider this disease as a cause of chronic visceral pain...