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Please use this identifier to cite or link to this item: http://hdl.handle.net/11055/586
Title: Stimulation of Dorsal Root Ganglia for the Management of Complex Regional Pain Syndrome: A Prospective Case Series
Authors: Van Buyten, Jean-Pierre
Smet, Iris
Liem, Liong
Russo, Marc
Huygen, Frank
ANZCA/FPM Author: Russo, M
Keywords: complex regional pain syndrome
CRPS
dorsal root ganglion
neuromodulation
spinal cord stimulation
neurostimulation
Issue Date: 6-Mar-2015
Citation: 15(3):208-216
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.
URI: http://hdl.handle.net/11055/586
DOI: 10.1111/papr.12170
PubMed URL: https://www.ncbi.nlm.nih.gov/pubmed/24451048
Journal Title: Pain Practice
Type: Journal Article
Affiliates: Multidisciplinary Pain Center, Algemeen Ziekenhuis Nikolaas
Sint Antonius Hospital, Nieuwegein
Hunter Pain Clinic
Erasmus University, Rotterdam
Study/Trial: Case Series and Case Reports
Appears in Collections:Scholarly and Clinical

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