What is DRG Stimulation?
Dorsal Root Ganglion Stimulation is a new procedure that has quickly gained popularity due to its success for neuropathic conditions and complex pain disorders.
Why is DRG Stimulation Performed?
Chronic pain can be highly debilitating for an individual as the pain lasts long past the average healing period, which may be even longer than six months. Data shows chronic pain, whether associated with Complex Regional Pain Syndrome, Post Amputation Pain, Pelvic diseases, or Post-Surgical pain, may affect more than 20% of individuals in the United States and Europe. This may lower one’s quality of life and interfere with everyday activities.
Chronic pain experienced by most individuals may be further classified into several types based on their nature. It may be neuropathic, nociceptive, and even nociplastic pain. Neuropathic pain is caused by diseases or lesions affecting the somato-sensory system. Where as nociceptive pain is caused by activation of the pain receptors themselves due to harmful triggers at the tissue level. The nociplastic type of pain was recently introduced as a type of pain associated with altered nociception despite no evidence of visible disease or tissue damage.
Dorsal Root Ganglion Stimulation allows a focused approach to target all the forms of pain mentioned above. This is because the dorsal root ganglion, a group of spinal nerves, contains all the crucial sensory neurons that send pain signals from the body’s peripheries to the spinal cord. Hence, the dorsal root ganglion can control what signals reach the nervous system and which signals will be blocked. Thus, when an individual has pain in any part of their body, the surgeon exclusively targets the group of nerves responsible for causing pain in that region –which in turn, effectively helps treat the pain.
How is DRG Stimulation Performed?
Dorsal Root Ganglion Stimulation is a minimally invasive procedure involving a thin lead implant placed under the skin. This implant is placed to target the Dorsal Root Ganglion and prevent its pain transmission to the brain. The procedure is conducted in two steps: The trial step and the permanent implantation step. The trial is where the trial simulator is connected to test whether it will be effective for the patients and their unique case, while the second step involves the permanent implantation to provide long-term pain relief.
The Trial Step
The trial for DRG stimulation is conducted in a surgical room, where the patient is given a low dose of anaesthesia. Once the anaesthetic effects takes place, the surgeon places the leads to the trial simulator over the Dorsal Root ganglion of the patient. After this, the patient is given a controller connecting to an external device, and they may be free to go home. The trial period of DRG stimulation may be conducted over five to seven days. During this time, the individual is encouraged to perform routine activities. However, they are required to be mindful of the external device that is connected to their body. The practices that should be avoided during the trial include exercises and activities involving bending, twisting, and heavy lifting. At the end of the trial period, the individual is asked to go to the clinic and get their leads removed.
Permanent Implantation
At the end of the trial period, if the patients report significant improvement in their pain intensity, they may be recommended to move to the next step, which is the permanent implantation. This procedure involves a small implant placed under the skin, similar to a pacemaker, which may be controlled by the individual externally using a controller.
What To Expect After DRG Stimulation
After completing the implantation procedure, the individual may be given an antibiotic to prevent an infection caused by an external device placed inside the body. After this, they are taken to a recovery room, where they are kept under observation until the anaesthesia has properly worn off. The doctor may also ask the patient to avoid strenuous activities for the next two months to allow adequate healing. The patient may also be called back to the clinic after a few days to evaluate the incision site and ensure there are no signs of infection. Once this is done, a DRG device company representative will schedule a meeting with the patient, where they will be instructed on how to turn it on and program it.
Advantages and Disadvantages of DRG Stimulation
Advantages Of DRG Stimulation
Pain Relief: The Dorsal Root Ganglion Stimulation has been highly effective in treating chronic pain in numerous studies. Experts often compare its effectiveness to spinal cord stimulation, as it is effective for complex regional pain syndrome, post-surgical pain, post-amputation pain, and even pelvic pain.
Easy Accessibility: A major advantage associated with DRG stimulation, is its easy accessibility. The Dorsal Root Ganglion can be accessed both inside the epidural space and outside through the neuroforamina.
Lower Risk For Migrations: Dorsal Root Stimulation is associated with a lower risk for device migration inside the body. It is also found to have lesser side effects when compared to other similar procedures like spinal cord stimulation and peripheral nerve stimulation.
Disadvantages Of DRG Stimulation
DRG Stimulation is a safe procedure with a low risk for side effects. In rare cases where these do happen, the side effects of DRG stimulation may include:
- Pain at the site of implantation
- Infection at the site of the incision
- Hardware malfunctioning of the device
- Dural Puncture while conducting the procedure
