Dorsal Root Ganglion Stimulation for Lower Extremity Neuropathic Pain Syndromes: An Evidence-Based Literature Review

Abstract

Dorsal root ganglion stimulation (DRG-S) is a form of selective neuromodulation therapy that targets the dorsal root ganglion. DRG-S offers analgesia in a variety of chronic pain conditions and is approved for treatment of complex regional pain syndrome (CRPS) by the US Food and Drug Administration (FDA). There has been increasing utilization of DRG-S to treat various neuropathic pain syndromes of the lower extremity, although evidence remains limited to one randomized controlled trial and 39 observational studies. In this review, we appraised the current evidence for DRG-S in the treatment of lower extremity neuropathic pain using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria. The primary outcome was change in pain intensity after DRG-S compared to baseline. We stratified presentation of results based of type of neuropathy (CRPS, painful diabetic neuropathy, mononeuropathy, polyneuropathy) as well as location of neuropathy (hip, knee, foot). Future powered randomized controlled trials with homogeneous participants are warranted.

Neuromodulation Therapy for Chemotherapy-Induced Peripheral Neuropathy: A Systematic Review

“…Given the stocking-glove distribution of CIPN which frequently involves multiple nerve distributions, the authors recommend offering dorsal column SCS as the neuromodulation intervention of choice due to its ability to target broader areas of pain. DRG-S also has the capability of providing alleviation across multiple nerve distributions, partly due to its mechanism of cross-talk between dorsal root ganglions at different levels [ 13 ]. PNS may be considered if the patient’s pain symptoms are primarily located in one to two nerve distributions.…”

“…Various stimulation waveforms, including tonic stimulation, high-frequency (10-kHz) stimulation, burst stimulation, differential target multiplexed stimulation, and closed-loop stimulation, can be delivered via dorsal column SCS [ 9 , 10 , 11 ]. DRG-S involves lead placement in the epidural space overlying the dorsal root ganglion [ 12 , 13 ]. PNS involves lead placement in close proximity to a target nerve that innervates the location of the painful area [ 14 , 15 ].…”

Implantable Peripheral Nerve Stimulation for Peripheral Neuropathic Pain: A Systematic Review of Prospective Studies

“…The literature has shown that in cases of appropriate patient selection, SCS can achieve a success rate in the range of 50–100%, approaching and even surpassing that of PNS [ 8 , 32 ]. However, the available evidence for DRG-S therapy for painful diabetic neuropathy (PDN) and polyneuropathy highlights low-quality GRADE evidence in pain reduction [ 9 ]. On the contrary, in the management of CRPS, a randomized, prospective trial showed clinical and statistical significance in pain relief, postural stability and mood improvements favoring DRG-S versus SCS therapy [ 32 ].…”

“…Currently, PNS is approved by the United States Food and Drug Administration (FDA) for the treatment of acute or chronic pain located in the low back, upper or lower extremities, and head [ 6 , 8 , 9 ]. Thus far, PNS has been applied for a variety conditions including: mononeuropathies, neuropathic limb pain, post-stroke shoulder pain, headache, plexus injuries, post-amputation pain or phantom limb pain (PLP), pelvic pain, complex regional pain syndrome (CRPS), and chronic low back pain.…”

Neuromodulation for Peripheral Nerve Regeneration: Systematic Review of Mechanisms and In Vivo Highlights

“…Current indications for SCS include post-laminectomy syndrome, back pain, and numerous other chronic pain conditions [ 20 ]. DRG-S has similar indications and has been found to be more efficacious than SCS for focal neuropathies and complex regional pain syndrome (CRPS) [ 21 , 22 ]. Likewise, PNS has indications for neuropathic pain and is best utilized when symptoms can be traced to a specific nerve [ 23 ].…”