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Stimulation of dorsal root ganglia for the management of complex regional pain syndrome: a prospective case series.
Pain Pract 2015; 15(3):208-16PP

Abstract

BACKGROUND

Complex regional pain syndrome (CRPS) is a chronic and progressive pain condition usually involving the extremities and characterized by sensorimotor, vascular, and trophic changes. Spinal cord stimulation (SCS) is an effective intervention for this condition, but is hampered by the technical challenges associated with precisely directing stimulation to distal extremities. Dorsal root ganglia (DRG) may be more effective as a physiological target for electrical modulation due to recruitment of the primary sensory neurons that innervate the painful distal anatomical regions.

METHODS

Eleven subjects diagnosed with uni- or bilateral lower-extremity CRPS were recruited as part of a larger study involving chronic pain of heterogeneous etiologies. Quadripolar epidural leads of a newly developed neurostimulation system were placed near lumbar DRGs using conventional percutaneous techniques. The neurostimulators were trialed; 8 were successful and permanently implanted and programed to achieve optimal pain-paresthesia overlap.

RESULTS

All 8 subjects experienced some degree of pain relief and subjective improvement in function, as measured by multiple metrics. One month after implantation of the neurostimulator, there was significant reduction in average self-reported pain to 62% relative to baseline values. Pain relief persisted through 12 months in most subjects. In some subjects, edema and trophic skin changes associated with CRPS were also mitigated and function improved. Neuromodulation of the DRG was able to provide excellent pain-paresthesia concordance in locations that are typically hard to target with traditional SCS, and the stimulation reduced the area of pain distributions.

CONCLUSIONS

Neuromodulation of the DRG appears to be a promising option for relieving chronic pain and other symptoms associated with CRPS. The capture of discrete painful areas such as the feet, combined with stable paresthesia intensities independent of body position, suggests this stimulation modality may allow more selective and consistent targeting of painful areas than traditional SCS.

Authors+Show Affiliations

Multidisciplinary Pain Center, Algemeen Ziekenhuis Nikolaas, Sint-Niklaas, Belgium.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24451048

Citation

Van Buyten, Jean-Pierre, et al. "Stimulation of Dorsal Root Ganglia for the Management of Complex Regional Pain Syndrome: a Prospective Case Series." Pain Practice : the Official Journal of World Institute of Pain, vol. 15, no. 3, 2015, pp. 208-16.
Van Buyten JP, Smet I, Liem L, et al. Stimulation of dorsal root ganglia for the management of complex regional pain syndrome: a prospective case series. Pain Pract. 2015;15(3):208-16.
Van Buyten, J. P., Smet, I., Liem, L., Russo, M., & Huygen, F. (2015). Stimulation of dorsal root ganglia for the management of complex regional pain syndrome: a prospective case series. Pain Practice : the Official Journal of World Institute of Pain, 15(3), pp. 208-16. doi:10.1111/papr.12170.
Van Buyten JP, et al. Stimulation of Dorsal Root Ganglia for the Management of Complex Regional Pain Syndrome: a Prospective Case Series. Pain Pract. 2015;15(3):208-16. PubMed PMID: 24451048.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Stimulation of dorsal root ganglia for the management of complex regional pain syndrome: a prospective case series. AU - Van Buyten,Jean-Pierre, AU - Smet,Iris, AU - Liem,Liong, AU - Russo,Marc, AU - Huygen,Frank, Y1 - 2014/01/23/ PY - 2013/07/26/received PY - 2013/11/01/accepted PY - 2014/1/24/entrez PY - 2014/1/24/pubmed PY - 2016/5/6/medline KW - complex regional pain syndrome KW - dorsal root ganglion KW - neuromodulation KW - prospective case study KW - spinal cord stimulation SP - 208 EP - 16 JF - Pain practice : the official journal of World Institute of Pain JO - Pain Pract VL - 15 IS - 3 N2 - BACKGROUND: Complex regional pain syndrome (CRPS) is a chronic and progressive pain condition usually involving the extremities and characterized by sensorimotor, vascular, and trophic changes. Spinal cord stimulation (SCS) is an effective intervention for this condition, but is hampered by the technical challenges associated with precisely directing stimulation to distal extremities. Dorsal root ganglia (DRG) may be more effective as a physiological target for electrical modulation due to recruitment of the primary sensory neurons that innervate the painful distal anatomical regions. METHODS: Eleven subjects diagnosed with uni- or bilateral lower-extremity CRPS were recruited as part of a larger study involving chronic pain of heterogeneous etiologies. Quadripolar epidural leads of a newly developed neurostimulation system were placed near lumbar DRGs using conventional percutaneous techniques. The neurostimulators were trialed; 8 were successful and permanently implanted and programed to achieve optimal pain-paresthesia overlap. RESULTS: All 8 subjects experienced some degree of pain relief and subjective improvement in function, as measured by multiple metrics. One month after implantation of the neurostimulator, there was significant reduction in average self-reported pain to 62% relative to baseline values. Pain relief persisted through 12 months in most subjects. In some subjects, edema and trophic skin changes associated with CRPS were also mitigated and function improved. Neuromodulation of the DRG was able to provide excellent pain-paresthesia concordance in locations that are typically hard to target with traditional SCS, and the stimulation reduced the area of pain distributions. CONCLUSIONS: Neuromodulation of the DRG appears to be a promising option for relieving chronic pain and other symptoms associated with CRPS. The capture of discrete painful areas such as the feet, combined with stable paresthesia intensities independent of body position, suggests this stimulation modality may allow more selective and consistent targeting of painful areas than traditional SCS. SN - 1533-2500 UR - https://www.unboundmedicine.com/medline/citation/24451048/Stimulation_of_dorsal_root_ganglia_for_the_management_of_complex_regional_pain_syndrome:_a_prospective_case_series_ L2 - https://doi.org/10.1111/papr.12170 DB - PRIME DP - Unbound Medicine ER -