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Neural Mechanisms of Cardiac Pain
Author Biography
Introduction
Anterolateral System
Somatic vs. Visceral Nociceptive Processing
Angina Pectoris
Sympathetic Sensory Innervation
Referred Pain
Vagal Sensory Innervation
Other Ascending Pathways
Central Sensitization
Thalamus and Cerebral Cortex
Currently selected section: Neurophysiology of Angina Pectorsis
Nausea and Vomiting

Dyspnea
Summary

 

Chapter 25:Neural Mechanisms of Cardiac Pain: Neurophysiology of Angina Pectorsis
        
Question 12.1

A man has intractable angina pectoris that leaves him almost bedridden. He is told of a relatively new procedure that may reduce his pain. In this procedure, under local anesthesia an electrode is placed along the posterior surface (dorsal columns) of his upper thoracic spinal cord. Electrical stimulation at high frequencies (~85 Hz) and low intensities (less than the intensity that would evoke motor responses) will be applied to the spinal cord. The idea is to find out from the patient where he felt somatic pain when he experienced angina; this identifies the regions to which pain is referred.

Then the spinal cord is electrically excited. The person will experience paresthesias, or sensations unrelated to an actual peripheral stimulus, that correspond to the spinal segments stimulated. For example, electrical stimulation in the cervical spinal cord could elicit paresthesias that seem to come from the arm, but stimulation in the lumbar spinal cord might elicit paresthesias that seem to come from the leg. The electrode is adjusted so that the regions of his body to which the pain is referred are the same regions that the patient senses paresthesias when the electrode is stimulated.

Would this procedure alleviate the pain or enhance it?

Selection AAlleviate the pain
Selection BEnhance the pain

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