Case of the Month #19: Refractory Angina by Dr Sonia Pierce
The multidisciplinary team formulated a plan, involving the patient in the decision-making process. She had been directed by her cardiologist to some patient information resources on angina1. During the assessment session with the pain service, the team took time to explain her diagnosis of persistent or refractory angina. She agreed to have further input from the pain service psychologist, as well as a series of sessions with the pain service occupational therapist to help her develop her understanding of pain in the context of angina. This would include work on her health beliefs and anxiety related to her pain. She still experiences her angina symptoms and is developing pain self-management techniques to use during episodes of Angina. Mrs A is due to see the cardiology team in the tertiary centre soon. However, she admits she is now less frightened by her episodes of chest pain, and she now feels she is getting the support from her family and friends she needs to cope with her long-term condition. Her pain is still present frequently, but she feels much more in control and has future goals, such as planning weekend visits to friends. Following their input, she may be referred to the tertiary refractory angina service for consideration of additional interventional approaches.