Stimulation of the Dorsal Root Ganglion for the Treatment of Chronic Pain (2024)

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Neuromodulation: Technology at the Neural Interface

One-Year Outcomes of Spinal Cord Stimulation of the Dorsal Root Ganglion in the Treatment of Chronic Neuropathic Pain

2014 •

Paul Verrills, Jean-pierre Van Buyten

Spinal cord stimulation of the dorsal root ganglion (DRG-SCS) is a new therapy for treating chronic neuropathic pain. Previous work has demonstrated the effectiveness of DRG-SCS for pain associated with failed back surgery syndrome, complex regional pain syndrome, chronic postsurgical pain, and other etiologies through 6 months of treatment; this report describes the maintenance of pain relief, improvement in mood, and quality of life through 12 months. Subjects with intractable pain in the back and/or lower limbs were implanted with an active neurostimulator device. Up to four percutaneous leads were placed epidurally near DRGs. Subjects were tracked prospectively for 12 months. Overall, pain was reduced by 56% at 12 months post-implantation, and 60% of subjects reported greater than 50% improvement in their pain. Pain localized to the back, legs, and feet was reduced by 42%, 62%, and 80%, respectively. Measures of quality of life and mood were also improved over the course of the study, and subjects reported high levels of satisfaction. Importantly, excellent pain-paresthesia overlap was reported, remaining stable through 12 months. Despite methodological differences in the literature, DRG-SCS appears to be comparable to traditional SCS in terms of pain relief and associated benefits in mood and quality of life. Its benefits may include the ability to achieve precise pain-paresthesia concordance, including in regions that are typically difficult to target with SCS, and to consistently maintain that coverage over time.

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Pain Practice

Stimulation of Dorsal Root Ganglia for the Management of Complex Regional Pain Syndrome: A Prospective Case Series

2014 •

Marc Russo

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Neuromodulation

Comparing the Efficacy of Dorsal Root Ganglion Stimulation With Conventional Medical Management in Patients With Chronic Postsurgical Inguinal Pain: Post Hoc Analyzed Results of the SMASHING Study

2022 •

Dirk Stronks

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Comparing the efficacy of targeted spinal cord stimulation (SCS) of the dorsal root ganglion with conventional medical management (CMM) in patients with chronic post-surgical inguinal pain: Preliminary results of the SMASHING study

2018 •

Ismail Gültuna

Introduction: Approximately 10% of patients who undergo a standard inguinal hernia mesh repair or Pfannenstiel incision, develop chronic (>3 months) postsurgical inguinal pain (PSIP). If medication or peripheral nerve blocks fail, surgery including neurectomies and/or mesh removal are the designated last resort treatments. A small proportion of patients, however, does not respond to any of the currently available remedial treatment modalities. Targeted spinal cord stimulation (SCS) of the dorsal root ganglion (DRG) is found to significantly reduce chronic PSIP in specific patients. Methods: In this multicentre, randomized controlled study, DRG SCS (Axium SCS system, Abbott, Chicago, USA) was compared to conventional medical management (CMM; non-invasive treatments such as medication, TENS and rehabilitation therapy) in PSIP patients who were refractory to a neurectomy. Patients were recruited at a tertiary referral center for groin pain (SolviMáx, Eindhoven, the Netherlands) betw...

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January 2018

Dorsal Root Ganglion Stimulation (DRGS) for the Treatment of Chronic Neuropathic Pain: A Single-Center Study with Long-Term Prospective Results in 62 Cases

2018 •

Guilherme Lepski

Background: Dorsal root ganglion stimulation (DRGS) treats discrete, localized areas of neuropathic pain. But there are no long-term results available so far. Objectives: We studied the long-term outcome of DRGS used in the treatment of chronic neuropathic pain. Study Design: A prospective, longitudinal single center investigation. Setting: Academic medical center in Germany. Methods: Patients (age >18 years) with chronic neuropathic pain in the hands, back, legs, knees and feet were prospectively examined. After a successful test-trial (duration of 3-14 days, pain decrease > 50%), a permanent generator was implanted. The patients were re-examined after 1 year, 2 years and 3 years. We used the Visual Analogue Scale (VAS), the Pain Disability Index (PDI), the Pain Catastrophizing Scale (PCS), the Brief Pain Inventory (BPI), and, the Beck Depression Inventory (BDI) for our assessments. Results: We included 62 consecutive patients (27 females, 35 males, mean age 56.8 years, with ...

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Neuromodulation : journal of the International Neuromodulation Society

Retrospective Case Series on the Treatment of Painful Diabetic Peripheral Neuropathy With Dorsal Root Ganglion Stimulation

2018 •

Liong Liem

The dorsal root ganglion (DRG) has been identified as an important neural structure in the development and maintenance of chronic pain. We present a retrospective case series of patients with refractory painful diabetic peripheral neuropathy (PDPN) that underwent electrical stimulation of the DRG and report on changes in their overall perceived pain and complication rates. Ten diabetic males (mean age 65.2 [SD 8.8] years) with painful symptoms of the lower limbs were enrolled and trialed with up to four quadripolar percutaneous DRG stimulation leads between L2 and L5 spinal levels. Patients received a fully implantable neurostimulation system (Abbott Laboratories, Sunnyvale, CA, USA) immediately or after a successful trial period (>50% reduction in pain). Overall perceived pain was measured by visual analogue scale (VAS) at baseline, one-week postimplantation and one-, three-, six-, and twelve-month follow-up (n = 5). Ten patients were included in this retrospective study. Seven ...

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Pain practice : the official journal of World Institute of Pain

Spinal Cord Stimulation: Clinical Efficacy and Potential Mechanisms

2018 •

Srinivasa Raja

Spinal cord stimulation (SCS) is a minimally invasive therapy used for the treatment of chronic neuropathic pain. SCS is a safe and effective alternative to medications such as opioids, and multiple randomized controlled studies have demonstrated efficacy for difficult-to-treat neuropathic conditions such as failed back surgery syndrome. Conventional SCS is believed mediate pain relief via activation of dorsal column Aβ fibers, resulting in variable effects on sensory and pain thresholds, and measurable alterations in higher order cortical processing. Although potentiation of inhibition, as suggested by Wall and Melzack's gate control theory, continues to be the leading explanatory model, other segmental and supraspinal mechanisms have been described. Novel, non-standard, stimulation waveforms such as high-frequency and burst have been shown in some studies to be clinically superior to conventional SCS, however their mechanisms of action remain to be determined. Additional studi...

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Neuromodulation : journal of the International Neuromodulation Society

The Neuromodulation Appropriateness Consensus Committee on Best Practices for Dorsal Root Ganglion Stimulation

2018 •

Matthew Rupert

The Neuromodulation Appropriateness Consensus Committee (NACC) is dedicated to improving the safety and efficacy of neuromodulation and thus improving the lives of patients undergoing neuromodulation therapies. With continued innovations in neuromodulation comes the need for evolving reviews of best practices. Dorsal root ganglion (DRG) stimulation has significantly improved the treatment of complex regional pain syndrome (CRPS), among other conditions. Through funding and organizational leadership by the International Neuromodulation Society (INS), the NACC reconvened to develop the best practices consensus document for the selection, implantation and use of DRG stimulation for the treatment of chronic pain syndromes. The NACC performed a comprehensive literature search of articles about DRG published from 1995 through June, 2017. A total of 2538 article abstracts were then reviewed, and selected articles graded for strength of evidence based on scoring criteria established by the ...

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Neuromodulation: Technology at the Neural Interface

Neurophysiological Effects of Dorsal Root Ganglion Stimulation (DRGS) in Pain Processing at the Cortical Level

2018 •

Surjo Soekadar

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November 2019

Effectiveness of “Transgrade” Epidural Technique for Dorsal Root Ganglion Stimulation. A Retrospective, Single-Center, Case Series for Chronic Focal Neuropathic Pain

2019 •

Adnan Al-kaisy

Background: The recent interest in targeting the dorsal root ganglion (DRG) has led to the development of new techniques of electrode placement. In this article, we describe a new “Transgrade” approach to the DRG, accessing the contralateral interlaminar space and steering the lead out the opposite foramen. Objectives: The purpose of this study was to evaluate the Transgrade technique to the DRG in the management of focal neuropathic pain, predominately complex regional pain syndrome in terms of efficacy and safety. Study Design: A retrospective, observational review of all patients selected for DRG stimulation using the Transgrade technique to the DRG. Setting: Pain Management and Neuromodulation Centre, Guys and St. Thomas NHS Foundation Trust, London, United Kingdom. Methods: Data were taken from a hospital password-protected database. All patients were contacted by telephone for Numeric Rating Scale (NRS-11) score, Patient Global Impression of Change (PGIC) score, and complicati...

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Stimulation of the Dorsal Root Ganglion for the Treatment of Chronic Pain (2024)

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