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Background and Aims 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.

Methods 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.

Results 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.

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Abstract OP018 Figure 1

Anteroposterior projection of the chest x-ray shows the two electrodes of the spinal neurostimulator (yellow arrows), as well as the generator of the ICD and its two electrodes (red arrows)

Conclusions 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.