![]() Subsequently, a multicenter, comparative, prospective, controlled efficacy trial showed a statistically significant higher rate of treatment success, improvement in quality of life, functional status, and psychological disposition in patients with complex regional pain syndrome (CRPS) and causalgia when treated with DRG-S in comparison to SCS treatment. In 2011, the European Union and Australia approved the use of DRG-S after a multicenter study showed favorable efficacy in 76.5% of subjects with chronic, intractable neuropathic pain in trunk, sacrum, or lower limbs. ![]() However, DRG-S may have notable disadvantages including limited applicability in more widespread pain, difficulty of percutaneous placement, and difficulty or unfeasibility of placement in cases with neuroforaminal stenosis. Because the DRG only has a thin layer of cerebrospinal fluid around it, DRG-S is achieved with a lower electrical current, is less affected by positional changes, possesses more stability, and offers superior electrical efficiency and energy consumption compared to dorsal column SCS. ![]() This design allowed for precise targeting of nerve fibers that innervate the targeted painful regions without nonspecifically recruiting uninvolved dermatomes, even with areas that are typically more difficult to target with dorsal column spinal cord stimulation (SCS) like the groin and the foot. In 2009, a DRG-specific stimulator lead was developed with a much smaller diameter, increased flexibility, and reduced contact size. ĭRG-S was first described in a case report in 1998, when a conventional spinal cord stimulator lead was used to target the DRG in a patient with discogenic low back pain and resulted in 69% pain relief. DRG stimulation (DRG-S) is a form of selective neuromodulation therapy that targets these primary sensory neurons and offers analgesia in a variety of chronic pain conditions. DRG neurons are involved in the transduction of pain to the central nervous system (CNS), serving as a filter for propagation of afferent signals to the dorsal horn. The dorsal root ganglion (DRG) contains a collection of cell bodies of primary sensory, pseudo-unipolar neurons in the lateral epidural space of the spinal foramen. There is very low-quality evidence demonstrating promising results for DRG-S in painful diabetic neuropathy, focal neuropathy, and polyneuropathy.Įfficacy of DRG-S for refractory postsurgical neuropathic pain of the groin (e.g., post-herniorrhaphy) or of the knee (e.g., post-total knee arthroplasty) has been demonstrated in small-scale observational studies. The highest level of evidence is demonstrated with DRG-S use for CRPS of the lower extremity, although the quality of evidence was downgraded to “low” because of risk of bias, imprecision, heterogeneity, and indirectness from included observational studies. Future powered randomized controlled trials with homogeneous participants are warranted.ĭorsal root ganglion stimulation (DRG-S) is a form of selective neuromodulation therapy that targets the dorsal root ganglion and offers analgesia in a variety of chronic pain conditions.ĭRG-S is currently approved by the US Food and Drug Administration for the treatment of neuropathic pain associated with complex regional pain syndrome (CRPS) and/or causalgia in the groin and lower extremity. We stratified presentation of results based of type of neuropathy (CRPS, painful diabetic neuropathy, mononeuropathy, polyneuropathy) as well as location of neuropathy (hip, knee, foot). ![]() The primary outcome was change in pain intensity after DRG-S compared to baseline. In this review, we appraised the current evidence for DRG-S in the treatment of lower extremity neuropathic pain using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria. There has been increasing utilization of DRG-S to treat various neuropathic pain syndromes of the lower extremity, although evidence remains limited to one randomized controlled trial and 39 observational studies. DRG-S offers analgesia in a variety of chronic pain conditions and is approved for treatment of complex regional pain syndrome (CRPS) by the US Food and Drug Administration (FDA). Dorsal root ganglion stimulation (DRG-S) is a form of selective neuromodulation therapy that targets the dorsal root ganglion.
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