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Lack of body positional effects on paresthesias when stimulating the dorsal root ganglion (DRG) in the treatment of chronic pain.
Neuromodulation 2015; 18(1):50-7; discussion 57N

Abstract

OBJECTIVES

One prominent side effect from neurostimulation techniques, and in particular spinal cord stimulation (SCS), is the change in intensity of stimulation when moving from an upright (vertical) to a recumbent or supine (horizontal) position and vice versa. It is well understood that the effects of gravity combined with highly conductive cerebrospinal fluid provide the mechanism by which changes in body position can alter the intensity of stimulation-induced paresthesias. While these effects are well established for leads that are placed within the more medial aspects of the spinal canal, little is known about these potential effects in leads placed in the lateral epidural space and in particular within the neural foramina near the dorsal root ganglion (DRG).

MATERIALS AND METHODS

We prospectively validated a newly developed paresthesia intensity rating scale and compared perceived paresthesia intensities when subjects assumed upright vs. supine bodily positions during neuromodulation of the DRG.

RESULTS

On average, the correlation coefficient between stimulation intensity (pulse amplitude) and perceived paresthesia intensity was 0.83, demonstrating a strong linear relationship. No significant differences in paresthesia intensities were reported within subjects when moving from an upright (4.5 ± 0.14) to supine position 4.5 (± 0.12) (p > 0.05). This effect persisted through 12 months following implant.

CONCLUSIONS

Neuromodulation of the DRG produces paresthesias that remain consistent across body positions, suggesting that this paradigm may be less susceptible to positional effects than dorsal column stimulation.

Authors+Show Affiliations

Spinal Modulation, Inc., Menlo Park, CA, USA; University of Illinois College of Medicine, Peoria, IL, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

25147020

Citation

Kramer, Jeffery, et al. "Lack of Body Positional Effects On Paresthesias when Stimulating the Dorsal Root Ganglion (DRG) in the Treatment of Chronic Pain." Neuromodulation : Journal of the International Neuromodulation Society, vol. 18, no. 1, 2015, pp. 50-7; discussion 57.
Kramer J, Liem L, Russo M, et al. Lack of body positional effects on paresthesias when stimulating the dorsal root ganglion (DRG) in the treatment of chronic pain. Neuromodulation. 2015;18(1):50-7; discussion 57.
Kramer, J., Liem, L., Russo, M., Smet, I., Van Buyten, J. P., & Huygen, F. (2015). Lack of body positional effects on paresthesias when stimulating the dorsal root ganglion (DRG) in the treatment of chronic pain. Neuromodulation : Journal of the International Neuromodulation Society, 18(1), pp. 50-7; discussion 57. doi:10.1111/ner.12217.
Kramer J, et al. Lack of Body Positional Effects On Paresthesias when Stimulating the Dorsal Root Ganglion (DRG) in the Treatment of Chronic Pain. Neuromodulation. 2015;18(1):50-7; discussion 57. PubMed PMID: 25147020.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lack of body positional effects on paresthesias when stimulating the dorsal root ganglion (DRG) in the treatment of chronic pain. AU - Kramer,Jeffery, AU - Liem,Liong, AU - Russo,Marc, AU - Smet,Iris, AU - Van Buyten,Jean-Pierre, AU - Huygen,Frank, Y1 - 2014/08/21/ PY - 2013/05/14/received PY - 2014/04/04/revised PY - 2014/05/13/accepted PY - 2014/8/23/entrez PY - 2014/8/26/pubmed PY - 2015/12/31/medline KW - Chronic pain KW - dorsal root ganglion (DRG) KW - neuromodulation KW - position KW - spinal cord stimulation (SCS) SP - 50-7; discussion 57 JF - Neuromodulation : journal of the International Neuromodulation Society JO - Neuromodulation VL - 18 IS - 1 N2 - OBJECTIVES: One prominent side effect from neurostimulation techniques, and in particular spinal cord stimulation (SCS), is the change in intensity of stimulation when moving from an upright (vertical) to a recumbent or supine (horizontal) position and vice versa. It is well understood that the effects of gravity combined with highly conductive cerebrospinal fluid provide the mechanism by which changes in body position can alter the intensity of stimulation-induced paresthesias. While these effects are well established for leads that are placed within the more medial aspects of the spinal canal, little is known about these potential effects in leads placed in the lateral epidural space and in particular within the neural foramina near the dorsal root ganglion (DRG). MATERIALS AND METHODS: We prospectively validated a newly developed paresthesia intensity rating scale and compared perceived paresthesia intensities when subjects assumed upright vs. supine bodily positions during neuromodulation of the DRG. RESULTS: On average, the correlation coefficient between stimulation intensity (pulse amplitude) and perceived paresthesia intensity was 0.83, demonstrating a strong linear relationship. No significant differences in paresthesia intensities were reported within subjects when moving from an upright (4.5 ± 0.14) to supine position 4.5 (± 0.12) (p > 0.05). This effect persisted through 12 months following implant. CONCLUSIONS: Neuromodulation of the DRG produces paresthesias that remain consistent across body positions, suggesting that this paradigm may be less susceptible to positional effects than dorsal column stimulation. SN - 1525-1403 UR - https://www.unboundmedicine.com/medline/citation/25147020/Lack_of_body_positional_effects_on_paresthesias_when_stimulating_the_dorsal_root_ganglion__DRG__in_the_treatment_of_chronic_pain_ L2 - https://doi.org/10.1111/ner.12217 DB - PRIME DP - Unbound Medicine ER -