OP018 Spinal cord stimulation in a patient with an implantable cardioverter defibrillator for the management of chronic ischemic and neuropathic chest pain: a case report and focused review of the current literature

<h3></h3> <b>Please confirm that an ethics committee approval has been applied for or granted</b>: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission <h3>Background and Aims</h3> To present a successful case of pain relief using simultaneous use of spinal cord stimulation (SCS) and implantable cardioverter defibrillator (ICD) without interaction in a patient with refractory chest pain. <h3>Methods</h3> A 64-year-old man with a medical history of arterial hypertension, and multivessel coronary artery disease, previously underwent percutaneous coronary intervention and stent insertion and a severe ventricular dysfunction with an LVEF of 21% which is why the implantation of a dual chamber ICD was indicated. Later presented mixed etiology refractory chronic chest pain (ischemic and neuropathic), without response to multimodal pharmacological treatment, including high doses of opioids, among others, this being a limitation for the patient daily activities, so taking into account the previous treatments, he was taken to implant a spinal stimulator with two eight-contact electrodes at levels T6 and T7 and T3-T4. <h3>Results</h3> Pain perception before the procedure was 10/10 according to the visual analog pain scale, which presented a significant improvement in the postoperative period with a new value of 3/10 at 48 hours, 3/10 at 7 days and 2/10 at follow-up at 6 months with a 50% decrease in the opioid dose previously used by the patient. During follow-up, there were no alterations in ICD functioning after one year of the procedure. <h3>Conclusions</h3> For patients with cardiac implantable electronic devices such as pacemaker and ICD, spinal cord stimulation is a safe and effective treatment for chronic refractory pain.