gms | German Medical Science

Objective: Stimulation targeting the dorsal root ganglion (DRG) may be a therapy amenable to managing intractable post-herpetic neuralgia (PHN) since one of the etiologies is the inflammation of the sensory ganglia. We present the case report of patient from our center treated with SCS targeting the DRG.

Method: A 51-year-old female patient with PHN after a misdiagnosed herpes zoster infection of the right thorax was unsuccessfully treated at our center with nerve blocks. Drug therapy was stopped because the side effects such as constipation and constant fatigue became unbearable and compromised her ability to work as a music teacher. Her baseline pain intensity was 90 mm on visual analog scale (VAS) and she reported allodynia. She was referred to spinal cord stimulation (SCS) therapy. Based on our prior experience, we decided to implant her with SCS targeting the DRG.

Results: Based on her pain map, we implanted three flexible leads targeting the DRGs at T3, T5 and T7. Each lead created discrete, non-overlapping paresthesia in the appropriate dermatomes. The patient reported improved functionality. Her VAS at both 1 week and 2 weeks post-implant was 30 mm (67% pain reduction). She uses the stimulation just above her perception threshold (200-350 mA) to suppress allodynia and paroxysmal episodes. She describes the paresthesia as "relaxing" and "warming".

Conclusions: Preliminary results indicate that the targeted SCS therapy may be a viable option for treating intractable PHN. While the role of DRG in this disease condition has been well established, long-term maintenance of pain relief is yet to be determined.