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Neuromodulation for Chronic Refractory Angina

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Brain and Heart Dynamics

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Abstract

Angina pectoris is not a proportional indicator of the severity of occlusive coronary disease or myocardial ischemia; however, it is a key symptom of coronary artery disease. In a subgroup of patients suffering from long-lasting angina-type pain in the presence of myocardial ischemia, symptoms cannot be controlled by a combination of medical therapy, angioplasty, and coronary bypass surgery. Despite a relatively low mortality, these patients suffer high morbidity and frequent hospital admissions. This “refractory angina syndrome” is associated with important biopsychosocial issues and should be considered and treated as “chronic pain.”

Considering refractory angina pain as a chronic pain syndrome implies re-examining the entire neurophysiological pain pathways and questioning the Cartesian model. This also opens the gate to different hypothesis, including rethinking the symptom “angina” as a marker of ischemia only and looking at abnormal modulation processes involving pain pathways.

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Authors and Affiliations

  1. Interdisciplinary Pain Center, Swiss Pain Institute, Lausanne, Switzerland

    Philippe Mavrocordatos, Gustavo Rodrigues Costa Lages & Lucian Mihai Macrea

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  1. Philippe Mavrocordatos
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  2. Gustavo Rodrigues Costa Lages
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  3. Lucian Mihai Macrea
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Correspondence to Philippe Mavrocordatos .

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Editors and Affiliations

  1. Dept of Drug Sciences, Pharmacology Sect, University of Pavia, Dept of Drug Sciences, Pharmacology Sect, Pavia, Pavia, Italy

    Stefano Govoni

  2. Dept of Brain and Behavioural Sciences, University of Pavia Dept of Brain and Behavioural Sciences, Pavia, Pavia, Italy

    Pierluigi Politi

  3. Department of Molecular Medicine, University of Pavia, Department of Molecular Medicine, Pavia, Pavia, Italy

    Emilio Vanoli

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  1. Italian Pain Group, Milan, Italy

    Massimo Allegri

  2. Pain Therapy Service, Policlinico Monza Hospital, Monza, Italy

    Massimo Allegri

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Mavrocordatos, P., Lages, G.R.C., Macrea, L.M. (2019). Neuromodulation for Chronic Refractory Angina. In: Govoni, S., Politi, P., Vanoli, E. (eds) Brain and Heart Dynamics. Springer, Cham. https://doi.org/10.1007/978-3-319-90305-7_44-1

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