Dorsal Root Ganglion (DRG) Stimulation
DRG Stimulation is similar to typical Spinal Cord Stimulation but stimulates the DRG for more selective targeting of pain areas that are hard to reach. The DRG stimulator is implanted in a similar fashion to the typical spinal cord stimulator (SCS). However, unlike the traditional method, the leads (or small coated wires) stimulate the DRG and not the spinal cord. The DRG is a spinal structure packed with sensory nerves that transmit information to the spinal cord, which then conducts those signals to the brain.
DRG stimulation offers selective targeting of areas currently not as easily treated by traditional spinal cord stimulation, including the groin, lower leg and feet. This kind of stimulation is better for smaller, more specific areas of pain, as it can target a more specific area than traditional SCS, which is better for larger areas of pain. It is particularly effective in relieving chronic lower limb pain associated with complex regional pain syndrome (CRPS) and peripheral causalgia (nerve damage).
DRG stimulation also offers fewer side effects than traditional spinal cord stimulation. In a study done by St. Jude Medical, participants reported no difference in the intensity of paresthesia’s due to postural changes, which is a common side effect of traditional SCS therapy. This means that with traditional SCS therapy, sometimes a change in the patient’s posture can cause a difference in intensity or an abnormal sensation such as tingling or pricking. DRG provides a more focused stimulation that is typically confined to the painful area while helping to avoid unwanted stimulation.
The implantation process for the DRG stimulator is very similar to the implantation of a typical SCS. Like the typical SCS, the implantation of a DRG stimulator begins with a trial. A trial typically lasts 5 – 7 days. Typically, this procedure will be done at an ambulatory surgery center or hospital under light sedation. The trial stimulator leads are temporarily implanted percutaneously through an epidural needle into the epidural space (the area surrounding the spinal cord). Once the leads are in the epidural space, your physician will then position the leads to stimulate the DRG, instead of the spinal cord. The DRG is located in the lateral recesses of the epidural space. Your physician will know which DRG targets to stimulate based off of your pain complaints. Once the leads are properly placed, they are then connected to a trial stimulator battery that is external.
During the trial, patients are able to control their device to alleviate their pain. They can turn the device on and off as needed, they can turn the stimulation up or down for comfort, and there are multiple different programs they can use to help eliminate their pain. At the conclusion of the trial, the temporary leads will be removed and the patient and physician will determine if a permanent device is the right fit.
If you and your physician determine that the trial was successful, a permanent stimulator may be implanted. For the permanent implantation, the procedure will be done at an ambulatory surgery center or hospital under conscious sedation directed by an anesthesiologist. Two small incisions are made to complete the procedure. Permanent leads are implanted through the predetermined location in the epidural space. Next, the leads are connected to a battery. Once the leads are connected to the battery, it is implanted in the upper buttock or abdomen region. The procedure takes around 40 minutes to complete.
When the procedure is finished, the implant’s electrical pulses are programmed with an external control unit that the patient is able to use to control the system. Patients are trained in how to use the control unit before leaving. Once again they can use the control unit to turn the system on and off, adjust the stimulation level and switch between programs to alleviate their pain. The patient is able to go home after the procedure and the programming is done.
The DRG stimulator is a very exciting new advancement that is offered at Nevada Advanced Pain Specialists.
Nevada Advanced Pain Specialists is recognized as an industry leader in pain management. We have a state-of-the-art facility in Reno, Nevada, that allows for us to offer the highest possible level of quality care of our patients.
We are committed to providing a comprehensive and multi-disciplinary approach for each individual’s pain complaints to provide the most appropriate care. Our approach includes analysis of biomechanics, joint motion, as well as skeletal, nerve and muscle tissues. Every individual is evaluated for the root cause of their pain – not just a “quick fix” approach to only provide symptomatic relief.
Your pain will be evaluated with latest diagnostic tools and technologies used by the professionals at Nevada Advanced Pain Specialists to make accurate assessments including: EMG/Nerve testing, MRIs, x-rays, bone scans, and diagnostic pain injections.