Neurostimulation has been a go-to treatment for chronic back pain management for many years. Spinal cord stimulation in particular is often a recommended treatment option for refractory or intractable back pain that has not responded to other treatments. With spinal cord stimulation, a small electrical pulse is sent to the nerve, blocking out pain signals and replacing the pain with a mild tingling sensation. While this treatment works well for easy-to-reach areas of pain in the body, some patients have more complex pain that is more difficult to reach with traditional spinal cord stimulation. In these cases, a breakthrough new procedure called DRG stimulation may be the answer.
What is DRG stimulation?
DRG (dorsal root ganglion) stimulation targets a specific part of the spinal cord called the dorsal root ganglion. The dorsal root ganglion is a densely-packed cluster where the nerves begin to branch off from the dorsal column, the traditional target of spinal cord stimulation. DRG stimulation is able to target harder-to-reach nerves that can be associated with peripheral nerve pain, such as pain in the feet and legs.
In a year-long ACCURATE study of DRG stimulation as compared to traditional spinal cord stimulation, patients receiving DRG stimulation experienced significant reductions in pain with DRG stimulation over spinal cord stimulation (74.2% vs. 53%). Additionally, patients receiving DRG stimulation reported a near complete lack of the most prominent side effect (tingling in the nerve) as compared to patients with a traditional spinal cord stimulator (94.5% vs. 61.2%).
Robert Levy, M.D., director of the Marcus Neuroscience Institute in Boca Raton, Florida, and co-principal investigator of the ACCURATE study, highlighted the new treatment option now available to patients for whom other treatments were unsuccessful, noting:
“DRG stimulation represents hope to many patients eager for more meaningful treatment options for complex and hard-to-treat neuropathic chronic pain conditions. The data from the ACCURATE study have shown us that DRG stimulation yields long term meaningful pain relief for patients with complex regional pain syndrome and peripheral causalgia. The results of this trial are very exciting for those of us who treat patients with these debilitating conditions.”
The Axium™ Neurostimulator System is the system used by Arizona Pain, the first pain management clinic in Arizona to offer this innovative treatment. This is the only device that was specifically designed for DRG stimulation. This system is FDA-approved for use in the U.S. and works well for targeted pain relief especially in the groin, feet, and lower legs.
DRG stimulation provides an alternative from opioid therapy
As awareness grows about the ineffectiveness of opiates for long-term pain management, innovations in non-pharmacological pain management are crucial. In 2013, the Neuromodulation Appropriateness Consensus Committee (NACC) published new findings that indicated that those patients who utilized neurostimulation were less likely to need opioid therapy.
International Neuromodulation Society (INS) secretary and study co-author Dr. Marc Russo, director of the Hunter Pain Clinic in New South Wales, Australia, cited studies that indicated that neurostimulation was less invasive, less likely to result in opioid therapy, and a more successful approach to refractory back pain that previously might have required repeated surgery, noting:
“A reduction in opioid use among patients treated with spinal cord stimulation was shown in a several studies, notably a 2005 randomized controlled clinical trial led by Dr. Richard North under the auspices of the Johns Hopkins University School of Medicine. Broad-based studies show that within two years, using spinal cord stimulation rather than repeat back surgery is not only a more cost-effective use of health resources, it also is correlated with higher rates of return to work.”
Although these findings were related specifically to spinal cord stimulation, DRG stimulation provides a treatment option that is based on the same principles of blocking pain signals. The procedure for inserting a DRG stimulation device is considered minimally-invasive. Electrodes are implanted in the body directly on the dorsal root ganglion for the area being targeted. A stimulation device is implanted as well, usually in the lower back area. This stimulation device is powered by batteries and is programmable from outside the body. Batteries need to be replaced every two years.
The DRG stimulation device can be programmed at distinct intervals, depending on each patient’s need. When an electrical signal is sent, a tingling sensation may occur, but this is less likely to happen with DRG stimulation.
Because treatment of chronic pain is a complex and long-term process, the Neuromodulation Appropriateness Consensus Committee (NACC) has recommended specific guidelines for implementing neurostimulation that include:
- A commitment to continuing education for neurostimulation providers to improve outcomes
- Coordination of care with the patient’s other doctors, including cardiologists, neurologist, etc.
- Early implementation of neurostimulation (first-line treatment within the first two years of chronic pain) rather than waiting until trying everything else
- Utilizing hybrid treatments for hard-to reach pain that may include both spinal cord stimulation as well as DRG stimulation
As with any surgical procedure, there are some risks. However, DRG stimulation is a relatively safe procedure with very few adverse effects. Potential risks include the risk of infection, bleeding at the site of insertion, and a reaction to the local anesthetic used for the procedure. In general, the procedure and the device are considered safe, and most patients return to normal levels of activity within a day or two of the procedure.
If you have refractory or intractable pain that has not responded to other treatments, talk to your doctor about DRG stimulation.