Dorsal Root Ganglion (DRG) Stimulation!
Patients who suffer from Complex Regional Pain Syndrome (CRPS) Type I or II or potentially other causes of nerve pain in the legs have a new treatment option. Did you fail conventional treatment options for this pain and the pain is severe and affected your quality of life? Have you even tried traditional spinal cord stimulation without the success you wanted?
There is a new spinal cord simulator (SCS) that appears to be more beneficial for the treatment of pain in the distal extremities, and for pain that is specific to a certain area in the legs.
One of our main goals at the Spine and Pain Institute of New York is to be as precise as possible with our diagnoses and treatments. This is a reflection of the goals of any intervention in medicine in general. With this new method of stimulation allows us to target the actual nerve rather than an entire extremity, thus limiting our treatment to where you need it.
With traditional spinal cord stimulation, a spinal cord stimulator lead is placed over the epidural space, above the spinal cord and electrical signals are used to alter the transmission of pain from the trunk and extremities to the brain. The leads can be placed on either side of midline of the spine to direct the stimulation to the right or the left extremity. We are able to direct the stimulation to certain parts of the extremities, but in general we were unable to focus the stimulation on a particular area of the extremity.
DRG Stimulation now allows us to selectively target nerves and their corresponding nerve distribution.
What is the Doral Root Ganglion?
The Dorsal Root Ganglion is a cluster of cell bodies of the nerves that travel from the extremities into the brain. This collection of cell bodies forms a bulge within the nerve just before or as it enters the spinal canal. Nerves transmit signals from the extremities to the spinal cord. Generally there are no connections between the nerves before the spinal cord. A sensation or activation of the nerve transmits from the nerve ending to the spinal cord, and there it meets a new nerve and sends the signal up the spinal cord do the brain. Where the nerves meet is called a synapse.
We now know that within the DRG the cell bodies communicate and can downregulate (slow down) or up regulate (speed up) the nerve transmission. This ‘processing unit’ of the nerves prior to the entrance is an optimal place to intervene with the transmission of pain from the extremities or nerves along the trunk to the brain.
It’s called the DRG Stimulation, and there have been some clinical trials that have shown it to be superior pain relief over traditional SCS for certain conditions (the FDA clinical trial, ACCURATE Study, showed that electrically stimulating the ganglion offers patients better and more targeted pain relief from Complex Regional Pain Syndrome).
What is DRG Stimulation?
The DRG has been the target of treatments in the past with some mixed results. Now, Abbot Medical (formerly St. Jude’s Medical) has developed a stimulator that is placed on the DRG is able to alter the transmission of pain from the nerve to the spinal cord and thus the brain. In this procedure, a smaller, more bendable lead is directed out the foramen (space where the nerve enters the spinal canal) onto the Dorsal root Ganglion (DRG) and electric currents are used to block the transmission of the pain signals passing through the nerve. Because the DRG is not surrounded by spinal fluid as is the spinal cord, we are able to use levels of energy that are so low, one does not get the tingling sensation (paresthesia free) that one would get with traditional SCS. This means that the pain signals are blocked, and not ‘covered’ with another sensation (tingling). This also means that it uses less energy creating a longer battery life.
The DRG stimulator is performed as the traditional stimulator, with a trial period first of 5-7 days. This trial period involves no incisions and the generator is taped to the skin on the outside of the body. An Apple device is provided to the patient and it is used to communicate with the device through an app.
So what are the advantage of DRG stimulation?
- More targeted therapy
- Paresthesia free (No tingling sensation)
- Potentially better battery life
- Potential for less complications- lead migration and those secondary to paresthesias
- Potential expanded indications for future use
Potentially more indications in the future
DRG stimulation has already proven beneficial for CRPS/RSD. It has been beneficial for nerve damage from hernia surgery and abdominal surgeries (ilioinguinal neuralgia, iliohypogastric neuralgia, meralgia paresthetica), and post herpetic neuralgia (shingles).
There is also potential for the stimulation of the DRG to help with non-nerve (neuropathic) pain. From our own experience and from case reports by stimulating the DRG it is possible to get pain relief from bone and joint related pain. So patients with pain secondary to chronic joint pain before or after surgery or joint replacements or after surgery to joints now have an option for pain relief other than opioid medications.
Treatments such as for post knee replacement pain, inoperable knee pain, chronic post-surgical ankle pain, etc are considered experimental and not yet approved but are currently being studied and you may be a candidate for these treatments if appropriate.
To Learn More
If you are interested in an evaluation and discuss the Dorsal Root Ganglion Stimulation and the Axium Nerve Stimulator Generator, please contact our pain management experts at the California Spine and Pain Institute. We would be happy to make an appointment for a consultation and provide additional information about treatment options.