Neuromodulation : journal of the International Neuromodulation Society
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Dorsal root ganglion stimulation (DRGS) is an effective treatment for complex regional pain syndrome (CRPS) and post-surgical neuropathic pain. However, some patients have surgical and anatomical conditions that are contraindications to traditional DRGS technique. A novel transgrade approach to DRGS placement has been described and demonstrated effective for post spine surgery patients. We present three patients, each with a different reason in which DRGS would not be accessible via the traditional anterograde approach, who all had successful DRGS transgrade placement. ⋯ Barriers to anterograde foraminal access including previous implantation, previous instrumentation, and epidural adhesions may prevent DRGS placement in certain indicated patients. This can be especially challenging in patients who have failed other neuromodulation options like dorsal column stimulation. Our case series demonstrated that the transgrade technique can be successfully used in these cases to increase access to DRGS.
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Observational Study
Effect of Patient Characteristics on Clinical Outcomes More Than 12 Months Following Dorsal Root Ganglion Stimulation Implantation: A Retrospective Review.
Dorsal root ganglion (DRG) stimulation is an effective treatment option for lower extremity complex regional pain syndrome and other focal pain conditions. However, the patient characteristics that may predict long-term outcomes have not been defined. ⋯ This single-center retrospective study found patients prescribed chronic opioids at the time of DRG stimulator implantation had a higher likelihood of less than 50% pain relief and 80% pain relief at one month, three months, and 12 months follow-up visits.
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Complex regional pain syndrome (CRPS) can be effectively treated with spinal cord stimulation (t-SCS). There is also evidence that dorsal root ganglion (DRG) stimulation may be superior to t-SCS in CRPS. However, there has been no published data, to our knowledge, that looked at the concurrent use of t-SCS and DRG stimulation for treatment of CRPS. ⋯ Both t-SCS and DRG-S have been shown to be effective in treatment of patients with CRPS. In our study, concurrent use of t-SCS and DRG-S provided significant improvement in pain and function as compared to using either device alone. This suggests the potential that combination therapy with t-SCS and DRG-S may be beneficial in patients with CRPS. Further prospective studies are required to evaluate this concept.
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Dorsal root ganglion stimulation (DRGS) has become a popular neuromodulatory treatment for neuropathic pain. We used magnetoencephalography (MEG) to investigate potential biomarkers of pain and pain relief, based on the differences in power spectral density (PSD) during varying degrees of pain and how these oscillations change during DRGS-mediated pain relief. ⋯ Our results demonstrate increased low-frequency power spectral activity in chronic pain patients in the absence of stimulation which shifts toward higher frequency power spectrum activity in response to therapeutic DRGS. These cortical changes in response to DRGS provide support for the use of neuroimaging in the search for potential biomarkers of pain.
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The sensory cell somata in the DRG contain all equipment necessary for extensive GABAergic signaling and are able to release GABA upon depolarization. With this study, we hypothesize that pain relief induced by conventional dorsal root ganglion stimulation (Con-DRGS) in animals with experimental painful diabetic peripheral neuropathy is related to the release of GABA from DRG neurons. With use of quantitative immunocytochemistry, we hypothesize DRGS to result in a decreased intensity of intracellular GABA-immunostaining in DRG somata. ⋯ Con-DRGS does not affect the average intracellular GABA immunofluorescence staining intensity in DRG sensory neurons of those animals which showed significant pain reduction. Similarly, no soma size related changes in intracellular GABA immunofluorescence were observed following Con-DRGS.