In earlier articles we have considered the efficacy of Spinal Cord Stimulation (SCS) in the management of pain for people suffering CRPS. Now, a similar but more targeted procedure known as Dorsal Root Ganglion Stimulation is gaining momentum as an alternative to SCS in the treatment of chronic pain.
What is the Dorsal Root Ganglion?
The Dorsal Root Ganglion (DRG) is a branch nerve of the spinal cord. It acts a little bit like a traffic signal, controlling when nerve signals can enter the spinal cord to travel to the brain. New evidence suggests that it may be responsible for causing the hyperexcitability of the central nervous system which leads to a number of the symptoms most associated with CRPS, including allodynia and central sensitisation.
What is Dorsal Root Ganglion Stimulation?
In the more traditional SCS, leads are placed in the epidural space behind the spinal cord, further from the nerves. The DRG is very accessible and in DRG Stimulation this means that the leads can be placed much closer to the target nerves. This allows the system to better focus the stimulation on the areas where pain is felt, including areas where traditional SCS has struggled, such as the lower leg and foot.
In essence, DRG stimulation creates more red traffic lights, stopping pain signals from travelling to the brain.
There have been a number of clinical trials. One trial in America which mostly involved people suffering CRPS, found that at one year following implantation 74.2% of them reported greater than 50% pain relief. One third reported pain relief of 80% or more.
Is DRG Stimulation widely available?
In America, the Food and Drug Administration has given the green light to DRG Stimulation for the treatment of CRPS.
In the UK a number centres are now offering DRG Stimulation, including the Walton Centre in Liverpool and Oxford University Hospitals. It is also increasingly available privately.