![]() 2–4 None of these are possible with conventional t-SCS.Įarly basic science work identified filtering of afferent fibers at the DRG as the basic mechanism of action. Both modalities utilize a tonic waveform however, DRG-S has efficacy when delivered in a subthreshold, paresthesia-free manner, at frequencies as low as 4 Hz, and when delivered intermittently. Surrounded by dura mater and only partially by a thin layer of cerebrospinal fluid (CSF), DRG-S utilizes a fraction of the energy required. Targeting the somata of the pseudo-unipolar afferent nerve fibers allows access to all nerve fiber types. Stimulating at the DRG is currently accepted as an alternative form of neuromodulation used for complex regional pain syndrome I and II and dermatomal pain syndromes, although additional benefits compared to t-SCS are becoming apparent. Supporting basic science work is also demonstrating that on a cellular, mechanistic level, DRG-S is functioning in a different manner. 1 Additional studies have shown results differing from past t-SCS work, from potential treatment indications to functional and psychological outcomes. The pivotal ACCURATE study, published in 2017, demonstrated superiority of DRG-S to t-SCS in the treatment of complex regional pain syndrome (CRPS) and causalgia. Given its novelty, the corresponding body of evidence is evolving compared to longer-employed therapies. Dorsal root ganglion stimulation (DRG-S) is a novel form of neuromodulatory therapy, that, rather than placing the electrical field over the dorsal columns of the spinal cord, as with conventional, tonic spinal cord stimulation (t-SCS), is placed near the cell nuclei of the afferent neurons of the dorsal root ganglia (DRG). With the introduction of new medical therapies, there is an inevitable growth of fundamental knowledge and improvements in outcomes. Looking to the future of neuromodulation, DRG-S holds promise as a robust intervention for otherwise intractable pain. ![]() Best practice recommendations encompass safety management, implantation techniques, and mitigation of the potential complications reported in the literature. This document is composed of a comprehensive narrative literature review that has been performed regarding the role of the DRG in chronic pain and the clinical evidence for DRG-S as a treatment for multiple pain etiologies. Through funding and organizational leadership by the American Society for Pain and Neuroscience (ASPN), this best practices consensus document has been developed for the selection, implantation, and use of DRG stimulation for the treatment of chronic pain syndromes. ![]() Dorsal root ganglion stimulation (DRG-S) has significantly improved the treatment of complex regional pain syndrome (CRPS), and it has broad applicability across a wide range of other conditions. ![]() With continued innovations in neuromodulation comes the need for evolving reviews of best practices. ![]()
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