DRG Stimulation, A New Therapy for Neuropathic Pain
If you have a certain type of neuropathic pain, we may have good news for you! There is an exciting new type of therapy now available in the US, known as dorsal root ganglion (DRG) stimulation, now offered at North Shore Pain Management. This therapy has been available in Europe and Australia for several years, and in February 2016 was approved in the United States for the treatment of CRPS (Complex Regional Pain Syndrome, also known as RSD). DRG stimulation became available in Massachusetts in the summer of 2017. As one of the leading providers of DRG stimulation in New England, the physicians at North Shore Pain Management have been placing DRG stimulators since June 2017, with amazing results in patients whose pain has not responded to many other therapies, including spinal cord stimulation.
First, a little biology. The Dorsal Root Ganglia, or DRG, are bundles of sensory nerves that enter the spinal cord at each level, carrying signals from specific regions of the body into the spinal cord and up to brain to be processed and interpreted. Some of the nerves carry sensory signals that are interpreted by the brain as pain. In chronic and neuropathic (“nerve”) pain, these nerves become sensitized and hyperactive, sending too many signals, which the brain interprets as severe pain. That same sensitization of the nerves makes them more susceptible to neuromodulation (stimulation), which has the effect of quieting the nerves.
DRG stimulation is similar in some ways to spinal cord stimulation, also known as dorsal column stimulation. Both therapies involve a thin wire (or lead) inserted into the epidural space of the spine (the same area as epidural steroid injections), but in DRG stimulation the lead is then steered to lie along the DRG as the nerves enter the spinal cord, rather than staying in the spinal column. The lead is then attached to a small device which creates a small electrical impulse, measured in microamps, which quiets the over-active sensory nerves without affecting any other sensory nerves or other types of nerves. There is no sensation, such as buzzing or tingling, just a reduction in pain.
DRG stimulation has been approved for the treatment of CRPS, but can be useful for any type of focal neuropathic pain at or below the waist, including:
- diabetic neuropathy
- phantom limb pain
- post-herpetic neuralgia
- persistent foot, leg, knee, hip or abdominal pain after surgery.
In specific cases, neuropathic pain above the waist may be considered. Someone with widespread neuropathic pain, or with pain that is not neuropathic, is not likely to benefit, although may benefit from spinal cord stimulation. This is not a therapy for acute post-surgical or acute trauma pain.
If you are a candidate for DRG stimulation, the doctors at North Shore Pain Management will first do a trial, in which temporary leads are placed through a needle and attached to a small external device for power. The trial generally lasts about a week. During that time you will see how it works for you, and then the leads are removed at a follow-up visit. If you have significant relief of pain during the trial, you will then be scheduled for the permanent implant. The leads are placed again, but this time connected to a surgically implanted pulse generator, which is a little battery similar to a pacemaker. If you are a candidate, insurance will generally cover both the trial and the permanent implant.
Of course, pain is complicated. No therapy is guaranteed to be 100% effective, and everyone is a little different, so what may work beautifully for another person may not work well for you. You may find you have a lot of relief, some relief, or none at all. Many people, but not all, find that they can reduce or even discontinue pain medications. There are risks, although they are very small if you follow instructions during the trial and the post-implant period.
Our providers at North Shore Pain Management are experts on determining whether you may benefit from dorsal root ganglion stimulation, and can guide you through the whole process. North Shore Pain Management also offers patient information sessions 5-6 times a year, where you can meet with technical reps, one of our providers, and other people like you, interested in spinal cord and DRG stimulation. Find out if this is a therapy that would help you!
At North Shore Pain Management we provide advanced, evidence based, multidisciplinary and cost effective pain management. Our goal is to improve your ability to return to the activities you have been missing as well as provide a meaningful reduction in pain.