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DRG Stimulation - Neuromodulation of the Dorsal Root Ganglion

DRG Stimulation DRG Stimulator New York Treatment for CRPS NYCDo you have Complex Regional Pain Syndrome (CRPS) Type I or II? Are you suffering from severe pain in your lower limbs that has not been alleviated by any other treatments? Did you try traditional Spinal Cord Stimulation (SCS) with high hopes only to find that that failed to help as well?

Take heart…we have the answer you’ve been looking for!

The Ainsworth Institute of Pain Management is partnering with St. Jude Medical to offer a revolutionary new procedure that is set to change the whole way we approach treating CRPS. It’s called the DRG Stimulation, and it has already proven itself in clinical trials to offer superior pain relief over traditional SCS. [1],[2],[3]

St. Jude Medical and the Ainsworth Institute present the Axium – the only device FDA-approved for DRG Stimulation in the United States

What is DRG Stimulation?

DRG StimulationThe DRG in DRG Stimulation refers to the Dorsal Root Ganglion, also sometimes known as the posterior root ganglion. The Dorsal Root Ganglion lies at the posterior root of each spinal nerve. Pain signals travel from the lower limbs to the brain, on the way they must pass through the dorsal root ganglion.

The idea of DRG stimulation is nearly identical to traditional Spinal Cord Stimulation (SCS), with one very important difference – rather than placing the leads in a general region of the spinal cord, DRG stimulation targets the specific regions of the cord that are transmitting the pain and shuts down those painful signals directly by placing the leads DIRECTLY OVER THE DRG’s. 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 (CRPS). [4]

The Dorsal Root Ganglion – A Closer Look

DRG Stimulator DRG StimulationThe open space between each spinal vertebrae is called the intervertebral foramen. Several structures exist or pass through this opening. The dorsal and ventral spinal nerve roots, the spinal artery, veins, and the dorsal root ganglion.

The DRG is a cluster of neurons that exists in the dorsal nerve root. It is responsible for sensory function and carries signals to the brain from the peripheral nervous system. It controls temperature and pain sensations, and can be affected by traumatic injury or conditions such as a herniated disc.

Each neuron in the dorsal root ganglion contains a long, slender filament that conducts electrical impulses away from the cell body to the spinal cord. This filament is called an axon. Conversely the dendrite of each neuron receives information and passes it back to the cell body. [5]

How does the DRG create pain?

Previously, the DRG was thought of as a passive structure in the spinal cord, lacking involvement in the creation or maintenance of chronic, neuropathic pain.[6] The DRG was viewed as merely as a type of support system that facilitated communications between the peripheral and central nervous systems. However, newer evidence suggests the DRG is directly involved in the development of neuropathic pain (like CRPS) by creating hyperexcitability[7] and spontaneous, ectopic firingi of neurons contained within the DRG – this leads to central sensitization and clinical allodynia[8] (a classic symptom in CRPS where normal sensations like wind and wearing cloths becomes excruciating). When scientists pondered this role in the modulation of sensory processing and nociceptive pain as well as its easy accessibility within the body[9],[10], the DRG presented an interesting and highly plausible target for stimulation as a means to control pain.

Is DRG Stimulation Better than Traditional SCS?

DRG SCS DRG Stimulation Spinal Cord StimulationWhile the utility of spinal cord stimulation (SCS) is unquestioned, it does not help everyone every time and for some people, the relief tends to diminish over time. Among other things, there are number of deficiencies with the therapy that have kept it from becoming the gold-standard for certain types of pain: as many as 40% of implanted patients report unsatisfactory pain relief,[11] positional-related changes in the perception of neurostimulation,i above decreased pain relief over time despite appropriate coverage,[12].[13] the inability to consistently capture certain body parts like the foot and pelvic region[14],[15], and paresthesias in unwanted areas of the body. These shortcomings led clinicians to search for ways to improve SCS and close the gap on creating the ideal treatment modality for pain – out of this need dorsal root ganglion (DRG) stimulation was born. With DRG stimulation – there are no paresthesia, lower energy needs so recharging is less necessary, and there are no changes in coverage when changing positions.

See the Difference it Makes in a Real Patient?

How DRG Stimulation Does It Work?

DRG StimulationDRG Stimulation is a more advanced and refined version of traditional spinal cord stimulation. Instead of positioning the leads over the posterior aspect of the spinal cord, smaller and more precise leads are placed over the dorsal root ganglion itself. Specifically, the ganglia residing in the lumbar and sacral regions of the spine. This allows for greater and more targeted control of pain in the lower limbs.

In the industry’s largest study to date concerning lower limb pain associated with CRPS (ACCURATE Study), patients reported that the Axium DRG Stimulator gave them:

 Significantly greater pain relief than SCS
 No changes in paresthesia intensity (pins and needles sensation) when changing body position as compared to SCS.[16]
 A more precise and targeted area of administration i.e. no feeling of electrical stimulation outside their area of pain. [1]

DRG Stimulation has been used in other parts of the world for several years now. It has just been approved for use in the United States by the FDA in February of 2016. The success rates with this amazing new treatment have been nothing short of remarkable.

Pain Management NYCCRPS is a notoriously difficult neuropathic condition to treat. Patients often become understandably frustrated when treatments like Spinal Cord Stimulation fail to be effective. DRG Stimulation is exciting because it has the potential to succeed where every other treatment for CRPS has failed.

 

Corey W. Hunter, MD
Executive Director

Indications

The successes with DRG are astounding and are a huge improvement over the already immensely successful traditional spinal cord stimulation systems. Patients trialed with DRG stimulation have a greatly improved chance of success with much better pain relief.

In addition to CRPS, DRG stimulation can also treat:

 Discogenic pain due to degenerative disc disease [15]
 Post-herpetic neuralgia [17]
 Phantom limb pain [18]
 Groin pain after a hernia repair (postherniorrhaphy neuralgia) [17],[19]-[21]
 Lumbar radiculopathy [15]
 Foot pain [17]
 Neurapathic pain due to peripheral neuropathy [17]
 Neuropathic chest wall pain
 Lumbar stenosis
 Chronic postsurgical pain

If you’re considering getting a Spinal Cord Stimulator trial, find out if you’re a candidate for a DRG Stimulator first!  If you suffer from chronic, intractable lower limb pain caused by CRPS, give yourself the best chance at relief. Contact the Ainsworth Institute of Pain Management to to see if this amazing technologic advancement is right for you. 

References

[1] http://www.businesswire.com/news/home/20151211005787/en/

[2] Krames ES. The dorsal root ganglion on chronic pain and as a target for neuromodulation: a review. Neuromodulation 2015;18:24-32.

[3] Liem L, Russo M, Huygen FJPM, Van Buyten J, et al. One-year outcomes of spinal cord stimulation of the dorsal root ganglion in the treatment of chronic neuropathic pain. Neuromodulation 2015;18:41–49.

[4] http://www.businesswire.com/news/home/20160217005447/en/

[5] Urbanska, M.; Blazejczyk, M.; Jaworski, J. (2008). “Molecular basis of dendritic arborization”. Acta neurobiologiae experimentalis 68 (2): 264–288

[6] Krames ES. The dorsal root ganglion on chronic pain and as a target for neuromodulation: a review. Neuromodulation 2015;18:24-32.

[7] Sapunar D, Ljubkovicm M, Lirk P, McCallum JB, Hogan QH. Distinct membraine effects of spinal nerve ligation on injured and adjacent dorsal root ganglion neurons in rates. Anesthesiology 2005;103:360-363.

[8] Sukhotinzky I, Ben-Dor E, Raber P, Devor M. Key role of the dorsal root ganglion in neuropathic tactile hypersensibility. Eur J Pain 2004;8:135-143.

[9] Hasegawa T, An HS Haughton VM. Imaging anatomy of the lateral lumbar spinal canal. Semin Ultrasound CT MR 1993;14:404-413.

[10] Hasegawa T, Mikawa Y, Watanabe R. An HS. Morphometric analysis of the lumbosacral nerve roots and dorsal root ganglia by magnetic resonance imaging. Spine 1996;21:1005-1009.

[11] North RB. Neural intervace devices: spinal cord stimulation technology. Proc IEEE 2008;96:1108-1119.

[12] Turner JA, Loeser JD, Deyo RA, Sanders SB. Spinal cord stimulation for patients with failed back surgery syndrome or complex regional pain syndrome: a systemic review of effectiveness and complications. Pain 2004;108:137-147.

[13] Cameron T. Safety and efficacy of spinal cord stimulation for the treatment of chronic pain: a 20-year literature review. J Neurosurg 2004;100:254-267.

[14] Hunter C, Davé N, Diwan S, Deer T. Neuromodulation of Pelvic Visceral Pain: A Review of the Literature and Case Series of Potential Novel Targets for Treatment. Pain Practice 2013;13:3-17.

[15] Deer TR, Grigsby E, Weiner RL, Wilcosky B, Kramer JM. A prospective study of dorsal root ganglion stimulation for the relief of chronic pain. Neuromodulation 2013;16;67-72.

[16] Kramer J, Liem L, Russo M, Smet I, Van Buyten JP, Huygen F. Lack of body positional effects when stimulating the dorsal root ganglion (DRG) in the treatment of chronic pain. Neuromodulation 2015;18:50-57.

[17] Liem L, Russo M, Huygen FJPM, Van Buyten J, et al. One-year outcomes of spinal cord stimulation of the dorsal root ganglion in the treatment of chronic neuropathic pain. Neuromodulation 2015;18:41–49.

[18] Eldabe S, Burger K, Moser H, Klase D, Schu S, Wahlstedt A, Vanderick B, Francois E, Kramer J, Subbaroyan J. Dorsal root ganglion (DRG) stimulation in the treatment of phantom limb pain (PLP). Neuromodulation 2015;18:610–617.

[19] Schu S, Gulve A, El Dabe S, Baranidharan G, et al. Spinal Cord Stimulation of the Dorsal Root Ganglion for Groin Pain—A Retrospective Review. Pain Practice 2015;15:293-299.

[20] Hakeem A, Shanmugam V. Current trends in the diagnosis and management of postherniorraphy chronic groin pain. World J Gastrointest Surg. 2011 June 27; 3(6): 73-81.

[21] Cunningham J, Temple WJ, Mitchell P, Nixon JA, Preshaw RM, Hagen NA. Cooperative hernia study. Pain in the postrepair patient. Ann Surg. 1996; 224: 598-602.

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