Utilization of Concurrent Dorsal Root Ganglion Stimulation and Dorsal Column Spinal Cord Stimulation in Complex Regional Pain Syndrome

Tyurnikov

Simonyan³

et al. 2022

Clinical Case Reports

Section: Discussionmentioning

confidence: 99%

Epidural unilateral stimulation with “adaptive stim” option in treatment of type II CRPS

Tyurnikov

Simonyan³

et al. 2022

Clinical Case Reports

“…10 The potential that combination therapy with t-SCS and DRG-S may be beneficial in patients with severe and refractory CRPS. 11,12 Data from the ACCURATE study suggests that DRGS could be used in patients suffering from chronic intractable pain conditions that are refractory to t-SCS. 13 Unilateral epidural stimulation is an effective type of SCS in the treatment of pain syndromes.…”

Section: Discussionmentioning

confidence: 99%

Epidural unilateral stimulation with “Adaptive Stim” option in treatment of type II CRPS

Tyurnikov²,

et al. 2021

Preprint

“…Failure to progress in an interdisciplinary model/functional restoration algorithm and more intensive non-invasive therapies may warrant consideration of treatment with spinal cord stimulation or dorsal root ganglion stimulation. Conventional SCS stimulation offers an opportunity to inhibit the nociceptive pathways at the level of the dorsal column of the spinal cord, while DRG stimulation modulates pain signal pathways at the level of the dorsal root [ 382 ]. Data demonstrates pain reduction, improved quality of life and function, as well as a reduction in opioid pharmaceuticals when spinal cord stimulation is employed in the setting of failed conservative therapy [ 383 ].…”

Section: Interventional Therapiesmentioning

confidence: 99%

Complex Regional Pain Syndrome: Practical Diagnostic and Treatment Guidelines, 5th Edition

et al. 2022

There have been some modest recent advancements in the research of Complex Regional Pain Syndrome, yet the amount and quality of the work in this complicated multifactorial disease remains low (with some notable exceptions; e.g., the recent work on the dorsal root ganglion stimulation). The semi-systematic (though in some cases narrative) approach to review is necessary so that we might treat our patients while waiting for “better research.” This semi-systematic review was conducted by experts in the field, (deliberately) some of whom are promising young researchers supplemented by the experience of “elder statesman” researchers, who all mention the system they have used to examine the literature. What we found is generally low- to medium-quality research with small numbers of subjects; however, there are some recent exceptions to this. The primary reason for this paucity of research is the fact that this is a rare disease, and it is very difficult to acquire a sufficient sample size for statistical significance using traditional statistical approaches. Several larger trials have failed, probably due to using the broad general diagnostic criteria (the “Budapest” criteria) in a multifactorial/multi-mechanism disease. Responsive subsets can often be identified in these larger trials, but not sufficient to achieve statistically significant results in the general diagnostic grouping. This being the case the authors have necessarily included data from less compelling protocols, including trials such as case series and even in some instances case reports/empirical information. In the humanitarian spirit of treating our often desperate patients with this rare syndrome, without great evidence, we must take what data we can find (as in this work) and tailor a treatment regime for each patient.