Best Practices for Dorsal Root Ganglion Stimulation for Chronic Pain: Guidelines from the American Society of Pain and Neuroscience

Abstract

With continued innovations in neuromodulation comes the need for evolving reviews of best practices. Dorsal root ganglion stimulation (DRG-S) has significantly improved the treatment of complex regional pain syndrome (CRPS), and it has broad applicability across a wide range of other conditions. Through funding and organizational leadership by the American Society for Pain and Neuroscience (ASPN), this best practices consensus document has been developed for the selection, implantation, and use of DRG stimulation for the treatment of chronic pain syndromes. This document is composed of a comprehensive narrative literature review that has been performed regarding the role of the DRG in chronic pain and the clinical evidence for DRG-S as a treatment for multiple pain etiologies. Best practice recommendations encompass safety management, implantation techniques, and mitigation of the potential complications reported in the literature. Looking to the future of neuromodulation, DRG-S holds promise as a robust intervention for otherwise intractable pain.

Dorsal root ganglion stimulator—A targeted therapy for post‐herpetic neuralgia: The Middle East Experience

“…DRG‐S′ superiority to conventional spinal cord stimulation (SCS) has already been established in the landmark ACCURATE study. DRG‐S in contrast to SCS has efficacy when delivered in a subthreshold, paresthesia‐free manner even in lower frequencies (4 Hz) 15 …”

“…DRG-S in contrast to SCS has efficacy when delivered in a subthreshold, paresthesiafree manner even in lower frequencies (4 Hz). 15 SCS has been an established treatment for neuropathic pain conditions but considering the pathophysiology and localized pain, DRG stimulation presents itself as a better target in comparison. Evidence in support of DRG stimulation is accumulating.…”

Use of a Sheath and Stylet for a Difficult Dorsal Root Ganglion Stimulation Lead Extraction: A Case Report

“…5 Additional studies have reported promising results with DRG-S in the treatment of a variety of other chronic pain conditions including postherniorrhaphy pain, low back pain, peripheral neuropathy, and pelvic pain. 1 While DRG-S remains an area of active research, it may offer several potential advantages compared to traditional SCS including more focal anatomical targeting, less postural variation, lower risk of lead migration, and reduced energy consumption. 3 Written Health Insurance Portability and Accountability Act authorization was obtained from the patient for the publication of this case report.…”

“…To decrease the risk of lead migration, an S-shaped loop is created in the epidural space to relieve strain, and some providers may also anchor the lead to fascia with sutures or a tissue anchoring device. 1,2 After implantation, the lead is stabilized by surrounding ligamentous structures including the ligamentum flavum, superior transverse ligament, and transforaminal ligament. 3…”

“…To decrease the risk of lead migration, an S-shaped loop is created in the epidural space to relieve strain, and some providers may also anchor the lead to fascia with sutures or a tissue anchoring device. 1,2 After implantation, the lead is stabilized by surrounding ligamentous structures including the ligamentum flavum, superior transverse ligament, and transforaminal ligament. 3 Although its analgesic mechanisms remain incompletely understood, DRG-S is hypothesized to relieve pain through pain gating processes and increased T-junction filtering of pain signals at the level of the dorsal root ganglion as well as possible spinal and supraspinal modulatory effects.…”