Dorsal Root Ganglion Stimulation (DRGS) for the Treatment of Chronic Neuropathic Pain: A Single-Center Study with Long-Term Prospective Results in 62 Cases

Abstract

Background: Dorsal root ganglion stimulation (DRGS) treats discrete, localized areas of neuropathic pain. But there are no long-term results available so far. Objectives: We studied the long-term outcome of DRGS used in the treatment of chronic neuropathic pain. Study Design: A prospective, longitudinal single center investigation. Setting: Academic medical center in Germany. Methods: Patients (age >18 years) with chronic neuropathic pain in the hands, back, legs, knees and feet were prospectively examined. After a successful test-trial (duration of 3-14 days, pain decrease > 50%), a permanent generator was implanted. The patients were re-examined after 1 year, 2 years and 3 years. We used the Visual Analogue Scale (VAS), the Pain Disability Index (PDI), the Pain Catastrophizing Scale (PCS), the Brief Pain Inventory (BPI), and, the Beck Depression Inventory (BDI) for our assessments. Results: We included 62 consecutive patients (27 females, 35 males, mean age 56.8 years, with an age range from 28 to 82 years, 62/51 to permanent conversion) during the time period from March 2012 until March 2016. Fifty-one patients had a successful test-trial and a generator was implanted subsequently. Results after 3 years: the VAS dropped from Mdn = 8 to Mdn = 4 (P = 0.0001). The PDI decreased from Mdn = 45 to Mdn = 23 (P = 0.003). The PCS decreased from Mdn = 34 to Mdn = 21 (P = 0.001). The BPI dropped from Mdn = 73 to Mdn = 30 (P = 0.003). The BDI decreased from Mdn = 36 to Mdn = 21 (P = 0.010). Fourteen patients showed complications (27.4%). Limitations: This study is limited by the small number of patients in the single groups of the different pain locations. Conclusion: DRGS may be an effective long-term method of treating discrete, localized areas of chronic neuropathic pain. We would recommend DRGS for the treatment of chronic neuropathic pain in such areas. Key words: Knee pain, foot pain, hand pain, groin pain, neuromodulation, dorsal root ganglion stimulation, chronic neuropathic pain, paresthesia mapping

Safety Analysis of Dorsal Root Ganglion Stimulation in the Treatment of Chronic Pain

“…The overall incidence rate of 3.2% for DRG stimulation was comparable to the event rate for fully-implantable SCS systems (3.1%) from the same manufacturer and so represents a true comparison of rates given that the same requirements for reporting and methods for data collection were taken as a part of the required device vigilance monitoring. These rates are similar to those observed during the ACCURATE clinical trial conducted for FDA approval as well as those reported in the literature (11,12,15,17,18,30). The latter of these two data collection methods (clinical studies) yield fairly large ranges of events, mostly due to the heterogeneity in data collection methods, reporting decisions and the fact that data was obtained from different geographies as well as different clinical sites.…”

Effectiveness and Safety of Dorsal Root Ganglion Stimulation for the Treatment of Chronic Pain: A Pooled Analysis

“…These results are comparable to other published literature. Morgalla et al reported >70% responder rate for focal (mainly groin and knee) pain at three years (28,29). Moreover, a large retrospective study of 271 patients showed similar pain reduction regardless of focal area being treated (46).…”

Neuromodulative Schmerztherapie

“…Die Dorsalganglienstimulation ist eine wichtige Neue rung, mit der es erstmals möglich ist, kleine, abgeschlos sene Schmerzareale wie beispielsweise Knie oder Leisten schmerzen gezielt zu behandeln. Obwohl diese Stimula tionsform erst seit wenigen Jahren zur Verfügung steht, gibt es hierzu eine große Anzahl von Studien und Lang zeitergebnissen [29][30][31][32][33][34]. In einer Studie mit 62 Patien ten konnte gezeigt werden, dass über einen Zeitraum von 3 Jahren eine sehr gute Schmerzlinderung von mehr als 50 % erreicht werden konnte (p < 0,0001) [30].…”

“…Obwohl diese Stimula tionsform erst seit wenigen Jahren zur Verfügung steht, gibt es hierzu eine große Anzahl von Studien und Lang zeitergebnissen [29][30][31][32][33][34]. In einer Studie mit 62 Patien ten konnte gezeigt werden, dass über einen Zeitraum von 3 Jahren eine sehr gute Schmerzlinderung von mehr als 50 % erreicht werden konnte (p < 0,0001) [30]. Darüber hinaus scheint die Dorsalganglienstimulation insbeson dere bei CRPS der herkömmlichen Stimulation überlegen zu sein [35].…”