Three-Year Outcomes After Dorsal Root Ganglion Stimulation in the Treatment of Neuropathic Pain After Peripheral Nerve Injury of Upper and Lower Extremities

Abstract

Objectives Traumatic peripheral nerve injuries (PNI) often result in severe neuropathic pain which typically becomes chronic, is recalcitrant to common analgesics, and is associated with sleep disturbances, anxiety, and depression. Pharmacological treatments proven to be effective against neuropathic pain are not well tolerated due to side effects. Neuromodulative interventions such as peripheral nerve or spinal cord stimulation have generated mixed results and may be limited by reduced somatotopic specificity. Dorsal root ganglion (DRG) stimulation may be more effective in this etiology. Materials and Methods Twenty‐seven patients were trialed with a DRG neurostimulation system for PNI; trial success (defined as ≥50% pain relief) was 85%, and 23 patients received a permanent stimulator. However, 36‐month outcome data was only available for 21 patients. Pain, quality of life, mental and physical function, and opioid usage were assessed at baseline and at 3‐, 6‐, 12‐, 18‐, 24‐, and 36 months post‐permanent implant. Implant‐related complications were also documented. Results Compared to baseline, we observed a significant pain relief (p < 0.001) at 3 (58%), 12 (66%), 18 (69%), 24 (71%), and 36 months (73%) in 21 patients (52.5 ± 14.2 years; 12 female), respectively. Mental and physical function showed immediate and sustained improvements. Participants reported improvements in quality of life. Opioid dosage reduced significantly (p < 0.001) at 3 (30%), 12 (93%), 18 (98%), 24 (99%), and 36 months (99%), and 20 of 21 patients were completely opioid‐free after 36 months. There were five lead migrations and two electrode fractures (corrected by surgical intervention) and one wound infection (conservatively managed). Conclusions DRG neuromodulation appears to be a safe, effective, and durable option for treating neuropathic pain caused by PNI. The treatment allows cessation of often ineffective pharmacotherapy (including opioid misuse) and significantly improves quality of life.

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

“…Our study was set up to present pooled data up to one‐year post‐permanent implant as this is the most common follow‐up period in published literature. The field is moving toward collecting longer term outcomes as exemplified by recent congress presentations . These independent studies support effective pain relief and quality of life improvements up to three years post‐implant.…”

Dorsal Root Ganglion Stimulation for the Treatment of Non-Complex Regional Pain Syndrome Related Chronic Pain Syndromes: A Systematic Review

“…Pain syndrome etiology for these reports varied widely which included phantom limb pain, post‐Lyme disease peripheral neuropathic pain, anterior cutaneous nerve entrapment, postsurgical knee pain, neuropathic pain after peripheral nerve injury, diabetic peripheral neuropathy, refractory loin pain hematuria syndrome, and idiopathic small fiber neuropathy of the left foot. Eight out of nine patients reports (19,20,31,34,35,41–43) demonstrated 50% or greater pain relief, post‐trial period, when observed at the time of last follow‐up. In this group, (18/65) patients experienced complications including: lead dislocation (one requiring explant (43)), lead breakage, device pocket pain, device overstimulation, lead migration, and superficial wound infection.…”

“…There is early and limited evidence that suggests that DRGS may prove to be a beneficial salvage strategy in patients that lose SCS efficacy in the long term (15,16). In our review, we found: (10/28) mentioned failed conventional management without detailed description of specific treatments (17–25), (7/28) failed to mention the failure of early management (26–32), (3/28) reported patients failing pharmacological management only (33–35), and (9/28) detail specific failed early management therapies prior to DRGS treatment (25,36–43). Of these nine reports, (5/9) detailed the failure of SCS previous with (4/5) detailing patients specifically.…”

Dorsal Root Ganglion Stimulation for the Management of Chronic Neuropathic Pain: A Retrospective Case Series during Four Years follow-up in a Single Center

“…It must be considered that with the passage of time, increased experience reduces the rate of complications. [46,47].…”