Spinal Cord Stimulation for Refractory Chest Pain Without Objective Ischemia in a Patient With Prior Coronary Artery...

Refractory nonischemic chest pain in patients with prior coronary artery bypass grafting (CABG) and optimal medical therapy presents a significant management dilemma when conventional cardiac evaluations are nondiagnostic. We report a case of a 60-year-old male patient with prior CABG and multiple percutaneous coronary interventions who experienced recurrent admissions for severe chest pain despite angiographically patent grafts and nondiagnostic ischemic evaluations, requiring escalating opioid therapy for symptom control. Under fluoroscopic guidance, percutaneous epidural leads were placed at T6-T7 to target the T2-T4 cardiac dermatomes. During a four-day trial of spinal cord stimulation (SCS), he experienced complete resolution of chest pain, discontinued opioids, and returned to full functional capacity. Permanent implantation was performed without complications. At six-month follow-up, he remained pain-free (0/10), had no further hospital readmissions, and reported marked improvement in quality of life. We propose that SCS may provide analgesia through neuromodulation of dorsal column pathways and partial sympathetic tone modulation of cardiac accelerator fibers, optimizing myocardial oxygen supply-demand balance. This case highlights SCS as a promising analgesic strategy for refractory nonischemic chest pain in anesthesia practice.