Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014, 158(4):518-527 | DOI: 10.5507/bp.2014.028

Interventional treatment of pain in refractory angina. A review

Milos Dobiasa, Pavel Michaleka, Petr Neuzilb, Martin Striteskya, Paul Johnstonc
a Department of Anaesthesia and Intensive Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
b Department of Cardiology, Na Homolce Hospital, Prague
c Department of Anaesthetics, Antrim Area Hospital, Antrim, United Kingdom

Background: Refractory angina is characterized by repeated attacks of chest pain in patients on maximal anti-anginal pharmacotherapy, with a professional conscensus that further surgical or radiological revascularization would be futile. Refractory angina is a serious but relatively uncommon health problem, with a reported incidence of approximately 30 patients per million people/year. In this condition simply treating the associated pain alone is important as this can improve exercise tolerance and quality of life.

Methods: An extensive literature search using five different medical databases was performed and from this, eighty-three papers were considered appropriate to include within this review.

Results and Conclusion: Available literature highlights several methods of interventional pain treatment, including spinal cord stimulation and video-assisted upper thoracic sympathectomy which can provide good analgesia whilst 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 nine randomized controlled trials. Other potential treatment methods include stellate ganglion blocks, insertion of thoracic epidural or spinal catheters and transcutaneous electrical nerve stimulation. These approaches however appear more useful for diagnostic purposes and perhaps as short-term treatment measures.

Keywords: refractory angina, spinal cord stimulation, thoracic sympathectomy, stellate ganglion

Received: February 8, 2014; Accepted: May 22, 2014; Prepublished online: June 19, 2014; Published: December 9, 2014  Show citation

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Dobias, M., Michalek, P., Neuzil, P., Stritesky, M., & Johnston, P. (2014). Interventional treatment of pain in refractory angina. A review. Biomedical papers, 158(4), 518-527. doi: 10.5507/bp.2014.028

Link to: Letter to the editor. Re: Interventional treatment of pain in refractory angina. A review

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    References

    1. Task Force members; Montalescot G, Sechtem U, Achenbach S, Andreotti F, Arden C, Budaj A et al. 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013;34(38):2949-3003. Go to original source... Go to PubMed...
    2. Fritz AK, Faber P. Chronic cardiac chest pain. Contin Educ Anaesth Crit Care Pain 2012;12(6):302-6. Go to original source...
    3. Verdon F, Herzig L, Burnand B, Bischoff T, Pécoud A, Junod M, Mühlemann N, Favrat B. Chest pain in daily practice: ocurrence, causes and management. Swiss Med Wkly 2008;138(23-24):340-7. Go to PubMed...
    4. Fraker TD jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 guidelines for the management of patients with chronic stable angina. Circulation 2007;116(23):2762-72. Go to original source... Go to PubMed...
    5. De Jongste MJ, Tio RA, Foreman RD. Chronic therapeutically refractory angina pectoris. Heart 2004;90(2):225-30. Go to original source... Go to PubMed...
    6. Mannheimer C, Camici P, Chester MR, Collins A, DeJongste M, Eliasson T, Follath F, Hellemans I, Herlitz J, Luscher T, Pasic M, Thelle D. The problem of chronic refractory angina: report from the ESC Joint Study Group on the treatment of refractory angina. Eur Heart J 2002;23(5):355-70. Go to original source... Go to PubMed...
    7. Kim MC, Kini A, Sharma SK. Refractory angina pectoris: mechanism and therapeutic options. J Am Coll Cardiol 2002;39(6):923-34. Go to original source... Go to PubMed...
    8. Andréll P, Yu W, Gersbach P, Gillberg L, Pehrsson K, Hardy I, Ståhle A, Andersen C, Mannheimer C. Long-term effects of spinal cord stimulation on angina symptoms and quality of life in patients with refractory angina pectoris - results from the European Angina Registry Link Study (EARL). Heart 2010;96(14):1132-6. Go to original source... Go to PubMed...
    9. Mannheimer C, Carlsson CA, Emanuelsson H, Vedin A, Waagstein F, Wilhelmsson C. The effects of transcutaneous electrical nerve stimulation in patients with severe angina pectoris. Circulation 1985;71(2):308-16. Go to original source... Go to PubMed...
    10. Khogali SS, Miller M, Rajesh PB, Murray RG, Beattie JM. Video-assisted thoracoscopic sympathectomy for severe intractable angina. Eur J Cardiothorac Surg 1999;16(1):95-8. Go to original source... Go to PubMed...
    11. Richter A, Cederholm I, Jonasson L, Mucchiano C, Uchto M, Janerot-Sjöberg B. Effect of thoracic epidural analgesia on refractory angina pectoris: long-term home self-treatment. J Cardiothorac Vasc Anesth 2002;16(6):679-84. Go to original source... Go to PubMed...
    12. Arora RR, Chou TM, Jain D, Fleishman B, Crawford L, McKiernan T, Nesto RW. The Multicenter Study of Enhanced External CounterPulsation (MUST-EECP): effect of EECP on exercise-induced myocardial ischemia and anginal episodes. J Am Coll Cardiol 1999;33(7):1833-40. Go to original source... Go to PubMed...
    13. Zuozienė G, Laucevičius A, Leibowitz D. Extracorporeal shockwave myocardial revascularization improves clinical symptoms and left ventricular function in patients with refractory angina. Coron Artery Dis 2012;23(1):62-7. Go to original source... Go to PubMed...
    14. Wiener L, Cox JW. Influence of stellate ganglion block on angina pectoris and the post-exercise electrocardiogram. Am J Med Sci 1966;252(3):289-95. Go to original source... Go to PubMed...
    15. Kadowaki MH, Levett JM. Sympathectomy in the treatment of angina and arrhythmias. Ann Thorac Surg 1986;41(5):572-8. Go to original source... Go to PubMed...
    16. Rauck RL. Stellate ganglion block. Tech Reg Anesth Pain Manage 2001;5(1):88-93. Go to original source...
    17. Stanton-Hicks M. Complications of sympathetic blocks for extremity pain. Tech Reg Anesth Pain Manage 2007;11(3):148-51. Go to original source...
    18. Garneau SY, Deschamps A, Couture P, Levesque S, Babin D, Lambert J, Tardif JC, Perrault LP, Denault AY. Preliminary experience in the use of preoperative echo-guided left stellate ganglion block in patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth 2011;25(1):78-84. Go to original source... Go to PubMed...
    19. Moore R, Groves D, Hammond C, Leach A, Chester MR. Temporary sympathectomy in the treatment of chronic refractory angina. J Pain Symptom Manage 2005;30(2):183-91. Go to original source... Go to PubMed...
    20. Chester M, Hammond C, Leach A. Long-term benefits of stellate ganglion block in severe chronic refractory angina. Pain 2000;87(1):103-5. Go to original source... Go to PubMed...
    21. Forouzanfar T, van Kleef M, Weber WE. Radiofrequency lesions of the stellate ganglion in chronic pain syndromes: retrospective analysis of clinical efficacy in 86 patients. Clin J Pain 2000;16(2):164-8. Go to original source... Go to PubMed...
    22. Braun K. Paravertebral block and the electrocardiogram in angina pectoris. Br Heart J 1946;8(1):47-52. Go to original source...
    23. Wettervik C, Claes G, Drott C, Emanuelsson H, Lomsky M, Radberg G, Tygesen H. Endoscopic transthoracic sympathicotomy for severe angina. Lancet 1995;345(1):97-8. Go to original source... Go to PubMed...
    24. Kux E. The endoscopic approach to the vegetative nervous system and its therapeutic possibilities; especially in duodenal ulcer, angina pectoris, hypertension and diabetes. Dis Chest 1951;20(2):139-47. Go to original source... Go to PubMed...
    25. Tygesen H, Claes G, Drott C, Emanuelsson H, Lomsky M, Lurje L, Radberg G, Wennerblom B, Wettervik C. Effect of endoscopic transthoracic sympathicotomy on heart rate variability in severe angina pectoris. Am J Cardiol 1997;79(11):1447-52. Go to original source... Go to PubMed...
    26. Claes G, Drott C, Wettervik C, Tygesen H, Emanuelsson H, Lomsky M, Radberg G. Angina pectoris treated by thoracoscopic sympathectomy. Cardiovasc Surg 1996;4(6):830-1. Go to original source... Go to PubMed...
    27. Stritesky M, Dobias M, Demes R, Semrad M. Endoscopic thoracic sympathectomy - its effect in the treatment of refractory angina pectoris. Interact Cardio Vasc Thorac Surg 2006;5(4):464-8. Go to original source... Go to PubMed...
    28. Yoshida K, Inoue T, Hirakawa N, Node K. Endoscopic thoracic sympathectomy as a novel strategy for vasospastic angina refractory to medical treatments. J Cardiol 2008;52(1):49-52. Go to original source... Go to PubMed...
    29. Wilkinson HA. Radiofrequency percutaneous upper-thoracic sympathectomy. Technique and review of indications. N Eng J Med 1984;311(1):34-6. Go to original source... Go to PubMed...
    30. Wilkinson HA. Percutaneous radiofrequency upper thoracic sympathectomy. Neurosurgery 1996;38(4):715-25. Go to original source... Go to PubMed...
    31. Gabrhelik T, Michalek P, Adamus M, Berta E. Percutaneous upper thoracic radiofrequency sympathectomy in Raynaud phenomenon: a comparison of T2/T3 procedure versus T2 lesion with phenol application. Reg Anesth Pain Med 2009;34(5):425-9. Go to original source... Go to PubMed...
    32. Gabrhelik T, Stehlik D, Adamus M, Zalesak B, Michalek P. Radiofrequency upper thoracic sympathectomy in the treatment of critical upper limb ischemia - a case series. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2013;157(2):202-8. doi: 10.5507/bp.2011.055 Go to original source... Go to PubMed...
    33. Börjesson M, Andréll P, Mannheimer C. Spinal cord stimulation for long-term treatment of severe angina pectoris: what does the evidence say? Future Cardiol 2011;7(6):825-33. Go to original source... Go to PubMed...
    34. De Jongste MJ. Spinal cord stimulation for ischemic heart disease. Neurol Res 2000;22(3):293-8. Go to original source... Go to PubMed...
    35. Taylor RS, de Vries J, Buchser E, de Jongste MJ. Spinal cord stimulation in the treatment of refractory angina: systematic review and meta-analysis of randomised controlled trials. BMC Cardiovasc Disord 2009;9(1):13. Go to original source... Go to PubMed...
    36. Murphy DF, Giles KE. Dorsal column stimulation for pain relief from intractable angina pectoris. Pain 1987;28(3):365-8. Go to original source... Go to PubMed...
    37. Mannheimer C, Augustinsson LE, Carlsson CA, Manhem K, Wilhelmsson C. Epidural spinal electrical stimulation in severe angina pectoris. Br Heart J 1988;59(1):56-61. Go to original source... Go to PubMed...
    38. Di Pede F, Zuin G, Giada F, Pinato G, Turiano G, Bevilacqua M, Cazzin R, Raviele A. Long-term effects of spinal cord stimulation on myocardial ischemia and heart rate variability: results of a 48-hour ambulatory electrocardiographic monitoring. Ital Heart J 2001;2(9):690-5. Go to PubMed...
    39. Hautvast RW, DeJongste MJ, Staal MJ, van Gilst WH, Lie KI. Spinal cord stimulation in intractractable angina pectoris: A randomized controlled efficacy study. Am Heart J 1998;136(6):1114-20. Go to original source... Go to PubMed...
    40. Jessurun GA, DeJongste MJ, Hautvast RW, Tio RA, Brouwer J, van Lelieveld S, Crijns HJ. Clinical follow-up after cessation of chronic electrical neuromodulation in patients with severe coronary artery disease: a prospective randomized controlled study on putative involvement of sympathetic activity. Pacing Clin Electophysiol 1999;22(10):1432-9. Go to original source... Go to PubMed...
    41. Eddicks S, Maier-Hauff K, Schenk M, Müller A, Baumann G, Theres H. Thoracic spinal cord stimulation improves functional status and relieves symptoms in patients with refractory angina pectoris: the first placebo-controlled randomised study. Heart 2007;93(5):585-90. Go to original source... Go to PubMed...
    42. Lanza GA, Grimaldi R, Greco S, Ghio S, Sarullo F, Zuin G, De Luca A, Allegri M, Di Pede F, Castagno D, Turco A, Sapio M, Pinato G, Cioni B, Trevi G, Crea F. Spinal cord stimulation for the treatment of refractory angina pectoris: a multicenter randomized single-blind study (the SCS-ITA trial). Pain 2011;152(1):45-52. Go to original source... Go to PubMed...
    43. Zipes DP, Svorkdal N, Berman D, Boortz-Marx D, Henry T, Lerman A, Ross E, Turner M, Irwin C. Spinal cord stimulation therapy for patients with refractory angina who are not candidates for revascularization. Neuromodulation 2012;15(6):550-9. Go to original source... Go to PubMed...
    44. Mannheimer C, Eliason T, Augustinsson LE, Blomstrand C, Emanuelsson H, Larsson S, Norrsell H, Hjalmarsson A. Electrical stimulation versus coronary artery bypass surgery in severe angina pectoris: the ESBY study. Circulation 1998;97(12):1157-63. Go to original source... Go to PubMed...
    45. McNab D, Khan SN, Sharples LD, Ryan JY, Freeman C, Caine N, Tait S, Hardy I, Schofield PM. An open-label, single-centre, randomized trial of spinal cord stimulation vs. percutaneous myocardial laser revascularization in patients with refractory angina pectoris: the SPiRiT trial. Eur Heart J 2006;27(9):1048-53. Go to original source... Go to PubMed...
    46. Eldabe S, Raphael J, Thomson S, Manca A, de Belder M, Aggarwal R, Banks M, Brookes M, Merotra S, Adeniba R, Davies E, Taylor RS. The effectiveness and cost-effectiveness of spinal cord stimulation for refractory angina (RASCAL study): study protocol for a pilot randomized controlled trial. Trials 2013;14(1):57. Go to original source... Go to PubMed...
    47. Greco S, Auriti A, Fiume G, Gazzeri G, Gentilucci G, Antonini L, Santini M. Spinal cord stimulation for the treatment of refractory angina pectoris: a two-year follow-up. Pacing Clin Electrophysiol 1999;22(1):28-32. Go to original source... Go to PubMed...
    48. De Jongste MJ, Haaksma J, Hautvast RW, Hillege HL, Meyler PW, Staal MJ, Sanderson JE, Lie KI. Effects of spinal cord stimulation on myocardial ichaemia during daily life in patients with severe coronary artery disease: a prospective ambulatory electrocardiographic study. Br Heart J 1994;71(5):413-8. Go to original source... Go to PubMed...
    49. Murray S, Carson KG, Ewings PD, Collins PD, James MA. Spinal cord stimulation significantly decreases the need for acute hospital admission for chest pain in patients with refractory angina pectoris. Heart 1999;82(1):89-92. Go to original source... Go to PubMed...
    50. TenVaarwerk IA, Jessurun GA, DeJongste MJ, Andersen C, Mannheimer C, Eliasson T, Tadema W, Staal M. Clinical outcome of patients treated with spinal cord stimulation for therapeutically refractory angina pectoris. TheWorking Group on Neurocardiology. Heart 1999;82(1):82-8. Go to original source... Go to PubMed...
    51. Bondesson SM, Jakobsson U, Edvinsson L, Hallberg IR. Hospital utilization and costs for spinal cord stimulation compared with enhanced external counterpulsation for refractory angina pectoris. J Eval Clin Pract 2013;19(1):139-47. Go to original source... Go to PubMed...
    52. Yu W, Maru F, Edner M, Hellström K, Kahan T, Persson H. Spinal cord stimulation for refractory angina pectoris: a retrospective analysis of efficacy and cost-benefit. Coron Art Dis 2004;15(1):31-7. Go to original source... Go to PubMed...
    53. Hautvast RW, Ter Horst GJ, DeJong BM, DeJongste MJ, Blanksma PK, Paans AM, Korf J. Relative changes in regional cerebral blood flow during spinal cord stimulation in patients with refractory angina pectoris. Eur J Neurosci 1997;9(6):1178-83. Go to original source... Go to PubMed...
    54. Hautvast RW, Blanksma PK, De Jongste MJ, Pruim J, van der Wall EE, Vaalburg W, Lie KI. Effect of spinal cord stimulation on myocardial blood flow assessed by positron emission tomography in patients with refractory angina pectoris. Am J Cardiol 1996;77(7):462-7. Go to original source... Go to PubMed...
    55. Norrsell H, Eliasson T, Manheimer C, Augustinsson LE, Bergh CH, Andersson B, Waagstein F, Friberg P. Effect of pacing-induced myocardial stress and spinal cord stimulation on whole body norepinephrine spillover. Eur Heart J 1997;18(12):1890-6. Go to original source... Go to PubMed...
    56. Spinelli A, Lanza GA, Calcagni ML, Sestito A, Squeglia GA, Di Monaco A, Bruno I, Lamendola P, Barone L, Giordano A, Crea F. Effect of spinal cord stimulation on cardiac adrenergic nerve function in patients with cardiac syndrome X. J Nucl Cardiol 2008;15(6):804-10. Go to original source... Go to PubMed...
    57. Andersen C, Hole P, Oxhoj H. Does pain relief with spinal cord stimulation for angina conceal myocardial infarction? Br Heart J 1994;71(5):413-8. Go to original source... Go to PubMed...
    58. Eliasson T, Jern S, Augustinsson LA, Mannheimer C. Safety aspects of spinal cord stimulation in severe angina pectoris. Cor Art Dis 1994;5(10):845-50.
    59. Sanderson JE, Ibrahim B,Waterhouse D, Palmer RB. Spinal electrical stimulation for intractable angina - long term clinical outcome and safety. Eur Heart J 1994;15(6):810-4. Go to original source... Go to PubMed...
    60. Kumar K, Rizvi S. Cost-effectiveness of spinal cord stimulation therapy in management of chronic pain. Pain Med 2013;14(11):1631-49. Go to original source... Go to PubMed...
    61. Buiten MS, DeJongste MJ, Beese U, Kliphuis C, Durenkamp A, Staal MJ. Subcutaneous electrical nerve stimulation: a feasible and new method for the treatment of patients with refractory angina. Neuromodulation 2011;14(3):258-65. Go to original source... Go to PubMed...
    62. Goroszeniuk T, Pang D, Al-Kaisy A, Sanderson K. Subcutaneous target stimulation - peripheral subcutaneous field stimulation in the treatment of refractory angina: preliminary case reports. Pain Practice 2012;12(1):71-9. Go to original source... Go to PubMed...
    63. Levy RM. Differentiating the leaves from the branches in the tree of neuromodulation: the state of peripheral nerve field stimulation. Neuromodulation 2011;14(3):201-5. Go to original source... Go to PubMed...
    64. Borjesson M, Eriksson P, Dellborg M, Eliasson T, Mannheimer G. Transcutaneous electrical nerve stimulation in unstable angina pectoris. Coron Artery Dis 1997;8(8-9):543-50. Go to PubMed...
    65. Borjesson M. Visceral chest pain in unstable angina pectoris and effects of transcutaneous electrical nerve stimulation (TENS): a review. Herz 1999;24(2):114-25. Go to original source... Go to PubMed...
    66. Jessurun GA, Tio RA, De Jongste MJ, Hautvast RW, Den Heijer P, Crijns HJ. Coronary blood flow dynamics during transcutaneous electrical nerve stimulation for stable angina pectoris associated with severe narrowing of one major coronary artery. Am J Cardiol 1998;82(8):921-6. Go to original source... Go to PubMed...
    67. Mannheimer C, Carlsson CA, Vedin A, Wilhelmsson C. Transcutaneous electrical nerve stimulation (TENS) in angina pectoris. Pain 1986;26(3):291-300. Go to original source... Go to PubMed...
    68. Mannheimer C, Carlsson CA, Ericsson K, Vedin A, Wilhelmsson C. Transcutaneous electrical nerve stimulation in severe angina pectoris. Eur Heart J 1982;3(4):297-302. Go to original source... Go to PubMed...
    69. Jessurun GA, Hautvast RW, Tio RA, de Jongste MJ. Electrical neuromodulation improves myocardial perfusion and ameliorates refractory angina pectoris in patients with syndrome X: fad or future? Eur J Pain 2003;7(6):507-12. Go to original source... Go to PubMed...
    70. Sanderson JE, Woo KS, Chung HK, Chan WW, Tse LK, White HD. The effect of transcutaneous electrical nerve stimulation on coronary and systemic haemodynamics in syndrome X. Coron Artery Dis 1996;7(7):547-52. Go to original source... Go to PubMed...
    71. Hallén K, Hrafnkelsdóttir T, Jern S, Biber B, Mannheimer C, Roy SD. Transcutaneous electrical nerve stimulation induces vasodilation in healthy controls but not in refractory angina patients. J Pain Symptom Manage 2010;40(1):95-101. Go to original source... Go to PubMed...
    72. Blomberg S, Emanuelsson H, Kvist H, Lamm C, Pontén J, Waagstein F, Ricksten SE. Effects of thoracic epidural anesthesia on coronary arteries and arterioles in patients with coronary artery disease. Anesthesiology 1990;73(5):840-7. Go to original source... Go to PubMed...
    73. Clemensen SE, Thayssen P, Hole P. Epidural morphine for outpatients with severe anginal pain. Br Med J (Clin Res Ed) 1987;294(6570):475-6. Go to original source... Go to PubMed...
    74. Blomberg SG. Long-term home self-treatment with high thoracic epidural anesthesia in patients with severe coronary artery disease. Anesth Analg 1994;79(3):413-21. Go to original source... Go to PubMed...
    75. Gramling-Babb P, Miller MJ, Reeves ST, Roy RC, Zile MR. Treatment of medically and surgically refractory angina pectoris with high thoracic epidural analgesia: initial clinical experience. Am Heart J 1997;133(6):648-55. Go to original source... Go to PubMed...
    76. Richter A, Cederholm I, Fredrikson M, Mucchiano C, Traff S, Janerot-Sjoberg B. Effect of long-term thoracic epidural analgesia on refractory angina pectoris: a 10-year experience. J Cardiothorac Vasc Anesth 2012;26(5):822-8. Go to original source... Go to PubMed...
    77. Andersen C, Hole P. Long-term home treatment with epidural analgesia does not affect later spinal cord stimulation in patients with otherwise intractable angina pectoris. Clin J Pain 1998;14(4):315-9. Go to original source... Go to PubMed...
    78. Segal R, Murali S, Tipton K. Treatment of chronic unstable angina pectoris: use of a totally implantable programmable device for continuous intrathecal infusion of opiates: case report. Neurosurgery 1996;38(2):385-8. Go to original source... Go to PubMed...
    79. Cherry DA, Gourlay GK, Eldredge KA. Management of chronic intractable angina - spinal opioids offer an alternative therapy. Pain 2003;102(1-2):163-6. Go to original source... Go to PubMed...
    80. McGillion M, Arthur HM, Cook A, Carroll SL, Victor JC, L'Allier PL. Management of patients with refractory angina: Canadian Cardiovascular Society/Canadian Pain Society joint guidelines. Can J Cardiol 2012;28(Suppl 2):S20-41. Go to original source... Go to PubMed...
    81. Committee Members; Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina - summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients with Chronic Stable Angina). Circulation 2003;107(1):149-58. Go to original source... Go to PubMed...
    82. Hradec J, Bultas J, Zelizko M. Stable angina pectoris. Recommendations for diagnosis and treatment of the Czech Society of Cardiology. Cor Vasa 2010;52(9):543-61. [article in Czech] Go to original source...
    83. Rasmussen MB, Hole P, Andersen C. Electric spinal cord stimulation (SCS) in the treatment of angina pectoris: a cost-utility analysis. Neuromodulation 2004;7(1):89-96. Go to original source... Go to PubMed...

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