Dorsal Root Ganglion Stimulation for Complex Regional Pain Syndrome (CRPS) Recurrence after Amputation for CRPS, and Failure of Conventional Spinal Cord Stimulation

Göebel, Andreas; Lewis, Sarah; Phillip, Rhodri; Sharma, Manohar

doi:10.1111/papr.12582

Cited by 27 publications

(28 citation statements)

References 15 publications

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“…DRG stimulation is a logical option for treatment of phantom limb pain (PLP); however, publication on the topic has been limited to date [10,38,39]. Postamputation patients by definition have a nerve injury (neurotomy), and many suffer chronic stump, residual limb, and/or phantom pain.…”

Section: Methods/resultsmentioning

confidence: 99%

Neuromodulation of the Dorsal Root Ganglion for Chronic Postsurgical Pain

Antony

Schultheis

Jolly³

et al. 2019

Pain Medicine

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ObjectiveThe objective of this study is to review the available evidence for dorsal root ganglion (DRG) stimulation for the treatment of complex regional pain syndrome type II (CRPS II; peripheral causalgia) associated with chronic neuropathic postsurgical pain (NPP).DesignAvailable literature was identified through a search of the US National Library of Medicine’s Medline database, PubMed.gov. References from published articles also were reviewed for relevant citations.ResultsThe data published to date support the use of DRG stimulation to treat chronic NPP of the groin, knee, and foot. NPP following procedures such as thoracotomy, hernia surgery, and knee replacement surgery were identified as some of the conditions for which DRG stimulation is likely to be effective.ConclusionDRG stimulation is known to be an effective treatment for focal neuropathic pain. Currently, NPP of the foot, groin, and knee all appear to be the conditions with the most clinical experience, backed by a limited but growing body of evidence. However, prospective studies lag behind real-world clinical experience and are needed to confirm these findings.

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Section: Methods/resultsmentioning

confidence: 99%

Neuromodulation of the Dorsal Root Ganglion for Chronic Postsurgical Pain

Antony

Schultheis

Jolly³

et al. 2019

Pain Medicine

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“…Several studies showed good results using DRGS in the treatment of CRPS (21,29). In a study with CRPS and the failure of conventional SCS, DRGS provided sufficient pain relief (30). Eleven patients diagnosed with uni-or bilateral lower-extremity CRPS, were recruited in a prospective case series as part of a larger study involving chronic pain of heterogeneous etiologies.…”

Section: Crpsmentioning

confidence: 99%

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

et al. 2018

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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

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“…The remaining three case reports included a total of 17 participants who have previously failed various treatment; they measured pain intensity by numeric rating scale (NRS); and all participants showed >50% pain reduction at all follow-up time points (Table 1). 34–36…”

Section: Resultsmentioning

confidence: 99%

<p>Neuromodulation with electrical field stimulation of dorsal root ganglion in various pain syndromes: a systematic review with focus on participant selection</p>

Vuka¹,

Marciuš²,

Došenović³

et al. 2019

JPR

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Objective We conducted a systematic review about patient selection, efficacy, and safety of neuromodulation with electrical field stimulation (EFS) of dorsal root ganglion (DRG) in various painful conditions. We also analyzed conclusion statements as well as conflict of interest and financing of the included studies. Methods All study designs were eligible for inclusion. We searched MEDLINE, CINAHL, Embase, PsycINFO, and clinical trial registries until September 7, 2018. We assessed risk of bias by using Cochrane tool for randomized controlled trials (RCTs). Results Among the 29 included studies, only one was RCT, majority being case series and case reports. The evidence is based on studies with small number of participants (median: 6, range 1–152) with various painful conditions. Neuromodulation with EFS of DRG was mostly performed in participants who have failed other treatment modalities. Most of the authors of the included studies reported positive, but inconclusive, evidence regarding efficacy of neuro-modulation with EFS of DRG. Meta-analysis was not possible since only one RCT was included. Conclusion Available evidence suggest that neuromodulation with EFS of DRG may help highly selected participants with various pain syndromes, who have failed to achieve adequate pain relief with other pharmacological and nonpharmacological interventions. However, these findings should be confirmed in high-quality RCTs with sufficient numbers of participants.

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Dorsal Root Ganglion Stimulation for Complex Regional Pain Syndrome (CRPS) Recurrence after Amputation for CRPS, and Failure of Conventional Spinal Cord Stimulation

Cited by 27 publications

References 15 publications

Neuromodulation of the Dorsal Root Ganglion for Chronic Postsurgical Pain

Neuromodulation of the Dorsal Root Ganglion for Chronic Postsurgical Pain

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

<p>Neuromodulation with electrical field stimulation of dorsal root ganglion in various pain syndromes: a systematic review with focus on participant selection</p>

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