1.6 Pain interventions 1.6.1 Do not offer the following interventions to manage stable angina: transcutaneous electrical nerve stimulation (TENS) enhanced external counterpulsation (EECP) acupuncture. 1.7 Stable angina that has not responded to treatment 1.7.1 Offer people whose stable angina has not responded to drug treatment and/or revascularisation comprehensive re-evaluation and advice, which may include: exploring the person's understanding of their condition exploring the impact of symptoms on the person's quality of life reviewing the diagnosis and considering non-ischaemic causes of pain reviewing drug treatment and considering future drug treatment and revascularisation options acknowledging the limitations of future treatment explaining how the person can manage the pain themselves specific attention to the role of psychological factors in pain development of skills to modify cognitions and behaviours associated with pain. 1.8 Cardiac syndrome X 1.8.1 In people with angiographically normal coronary arteries and continuing anginal symptoms, consider a diagnosis of cardiac syndrome X. 1.8.2 Continue drug treatment for stable angina only if it improves the symptoms of the person with suspected cardiac syndrome X. 1.8.3 Do not routinely offer drugs for the secondary prevention of cardiovascular disease to people with suspected cardiac syndrome X. Recommendations for research The Guideline Development Group has made the following recommendations for research, based on its review of evidence, to improve NICE guidance and patient care in the future. 1 Adding a newer anti-anginal drug to a calcium channel blocker What is the clinical and cost effectiveness of adding a newer anti-anginal drug (nicorandil, ivabradine or ranolazine) to a calcium channel blocker for treating stable angina? Why this is important We do not know the long-term clinical and cost effectiveness of adding a newer anti- anginal drug to a calcium channel blocker in people with stable angina. 