Article
A single center experience with dorsal root ganglion (DRG) stimulation for the treatment of neuropathic pain
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Authors
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Walter Demmel
- Neurochirurgische Praxis Fürstenfeldbruck
| Published: | June 2, 2015 |
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Outline
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Objective: Dorsal root ganglion (DRG), a neural structure that houses primary sensory neurons, is involved in the development and maintenance of chronic pain (Krames, 2014). Thus, targeting DRG through electrical stimulation could serve as a viable treatment for neuropathic pain. When conventional spinal cord stimulation (SCS) is used for the treatment of focal neuropathies, stimulation-induced paresthesia could extend beyond the area of pain causing discomfort to the patient. The unique anatomy of DRG allows for stimulation to be focused around the area of pain with minimal unwanted paresthesia. In this case series, we present a single center experience using DRG stimulation for the treatment of various etiologies.
Method: Patients with chronic intractable pain were trialed with Axium® neurostimulation system (Spinal Modulation, Inc.) and those with >50% pain relief at the end of the trial period were implanted with permanent stimulation system. Patients' pain scores (visual analog scale [VAS] in mm), medication intake, pain/paresthesia map were collected at baseline and each follow-up.
Results: Eleven patients were implanted with a total of 17 leads targeting C7 through L5 DRGs. Diagnoses include peripheral causalgia (PC) (7), trauma, congenital disorder, vascular anomaly and unknown (1 each). Four patients had failed prior neuromodulation therapies (SCS:3 and peripheral nerve stimulation, PNS: 1). VAS at baseline, 6 months, 12 months and 18 months were 80.7 mm (± 11.4, N=10), 30.7 (± 20.1, N=7), 41.0 (± 22.8, N=5) and 34.8 (± 11.0, N=4), respectively. Five patients had completely stopped medications while one patient had reduced medication intake by >50%. Three of the four patients that failed prior neuromodulation therapies had >50% pain relief at last follow-up (6-18 months). Paresthesia was focused and limited to the area of pain. In some cases, pain relief was achieved without paresthesia.
Conclusions: While the dataset is retrospective and the sample size small, relatively longer term follow-up demonstrated stable pain relief in this cohort of mostly PC patients. These outcomes, along with the limited side effect profile make this therapy a useful tool in the armamentarium of a pain physician.
