Vogel's pain was nearly crippling, preventing him from doing even simple things -- getting dressed and walking through his home. And conventional angina therapies weren't helping.

Then Vogel started a new therapy called spinal cord stimulation at the University of Michigan Health System. This treatment uses small electrical pulses to reduce pain and improve blood flow to the heart.

Almost immediately, Vogel's pain eased.

"I can do everything now. I'm truly blessed to have this," Vogel says. "I have control over this pain now, which I never had."

The U-M is the only facility in the state now offering spinal cord stimulation as a treatment for the most severe angina sufferers. Soon, the university will participate in a nationwide clinical trial to formally study the remarkable effects of this treatment.

Nearly 7 million Americans like Vogel suffer with daily pain from angina brought on by poor blood supply to the heart. The pain is a symptom of coronary artery disease.

Most angina can be treated with medication and surgery. But for 5 percent to 10 percent of sufferers, those treatments don't relieve the pain.

"Angina is a term for what is usually a chronic condition caused by a narrowed artery," says Kim Eagle, M.D., Albion Walter Hewlett Professor of Internal Medicine and interim chief, Division of Cardiology, in the University of Michigan Health System. "Although some patients may progress to have a heart attack, there are many patients who have angina and are receiving effective therapy who never had a heart attack."

Eagle estimates that 90 to 95 percent of those with angina are able to control their pain with traditional therapies, including medication such as nitroglycerin, lifestyle changes such as increased exercise and a low-fat diet, and such procedures as angioplasty and bypass.

"But for the other 5 percent to 10 percent, which still represents a large number of individuals, the spinal cord stimulator is clearly an option," Eagle says. "Our early experiences with it here at the University of Michigan have been very striking. We've had patients who have had a dramatic response.

"And as we learn more about the effects of the device on improving blood flow to the tiny arteries in the heart, it gives us even more confidence that we're not just masking a symptom of angina, but actually improving blood flow as well."

The spinal cord stimulator works by supplying very small doses of electricity to the cervical and upper thoracic spinal cord, explains Jeffrey Rosenthal, D.O., U-M clinical assistant professor of anesthesiology.

The spinal cord stimulator alters blood flow to the heart in such a way that areas with normal blood flow begin to supply other areas of the heart with poor blood flow, he says.

"The heart has its own pacemaker and its own electrical conducting system," Rosenthal says. "However, the heart is also under the influence of the spinal cord through the brain and brain stem. It's through this connection that we influence activity at the heart by using electrical pulses at the level of the spinal cord."

Once a patient is identified as a potential candidate for spinal cord stimulation, a stimulating electrode is placed through the skin in the neck to allow the patient to try out the treatment.

Although most patients know immediately if the device will help them, after five days, the patient and the doctor decide whether to proceed with the next stage -- the implantation of the battery and a receiver beneath the skin in the abdomen.

After implantation, the patient is given a handheld control unit that transmits radio waves through the abdominal wall to the receiver, triggering the electrical signals. This allows patients to have some control over the treatment of their pain, since they can increase the charge to relieve it at will.

The device seems to have great potential for treatment of angina with only minor risk, Rosenthal says. It will not mask a heart attack (but also, it will not protect against one.)

Vogel, who has the most severe form of the disease (Level 4 angina), says the spinal cord stimulator has changed his life. Before he received the device, "I was able to do nothing. I couldn't go up and down stairs. I couldn't take a shower. They had to bring a hospital bed in for me."

Vogel remembers well the day in June 1999 when he had the device implanted:

"I was on the operating table and they were implanting these spinal cord leads, and they turned the stimulator on," Vogel says. "I was having the angina at the time real bad. But when they adjusted the leads in my spine to cover the areas where I have angina, it was like a miracle. It masked the pain so perfectly. I knew at that moment it was going to work.

"Now I can get up out of bed. I can get dressed. I can wash my face, brush my teeth, shave. I can move around the house," Vogel says. "It gives you the control to be able to live your life like a normal human being."

Rosenthal says angina pain can be crippling:

"It can be incapacitating. It can severely impact activities of daily living. But patients who have had success with this therapy find that they are able to function in ways that they couldn't before. They can walk further. They can perform more around the house. They can get out and socialize with the family. They can enjoy life."

Although the spinal cord stimulator is relatively new in the U.S. for the treatment of angina, it has been used more commonly to treat patients with chronic back pain.

It has been studied for more than 10 years in Europe as a treatment for angina. Those studies have suggested that patients who use spinal cord stimulation may not only be getting relief from pain, but could indeed be improving the blood flow in some of those zones of the heart that are served by blocked arteries, Eagle said.

In addition to spinal cord stimulation, Eagle emphasizes that patients with severe angina who have not benefited from other treatments may consider other options.

One is laser-guided therapy, in which a laser is used to drill small holes in the heart to nourish areas of the heart muscle being served by very narrow arteries. A second option is a very aggressive lifestyle program and medication program developed at the U-M.

The U-M will be the only facility in Michigan to take part in the United States' clinical trial of spinal cord stimulation for the treatment of angina. And although Rosenthal and Eagle aren't sure when the trial will begin, they encourage patients who think they may be candidates for the spinal cord stimulator to discuss the matter with their doctors.

(Editor's Note: Patients interested in more information and those who would like to be notified when the clinical trial begins can leave a message at 1-800-742-2300, category 6220.)

Facts about angina and spinal cord stimulation treatment

· Angina is a severe, squeezing pain that usually starts in the center of the chest behind the breastbone and may spread to the arms, neck, jaw or back. It is caused by reduced oxygen to the heart, usually from poor blood supply, and is a symptom of coronary artery disease.

· Nearly 7 million Americans suffer with angina. Between 90 percent and 95 percent can be treated with medication, angioplasty or bypass surgery. About 5 percent to 10 percent must explore other options such as laser-guided surgery, a very aggressive lifestyle program or a relatively new treatment called spinal cord stimulation.

· Spinal cord stimulation uses electrical impulses to reduce pain and improve blood flow to the heart for angina sufferers. It works by supplying very small doses of electrical current to a key part of the spinal cord.

Related websites:

U-M Health Topics A to Z: Angina and Heart Attack

U-M Health Topics A to Z: Heart Information - Adult

American Heart Association: Angina Pectoris

American Heart Association: Angina Pectoris Treatments

[Contact: Valerie Gliem, Kara Gavin]

29-Jan-2001