Complex regional pain syndrome (CRPS) is a chronic and painful condition usually affecting the arms or lower extremities. The impacted extremity may involve the pelvis, groin, hip, knee, ankle, or foot. It can develop due to an injury, surgery, stroke, or heart attack. In some cases, it can occur without an apparent cause.
Those suffering from CRPS often have pain far out of proportion to whatever caused it. In addition to burning or throbbing pain, symptoms may include swelling, joint stiffness, muscle spasms, temperature sensitivity, and skin changes.
It is important to begin treatment of CRPS early. When it first appears, it presents the easiest opportunity to improve symptoms. But this condition can be a challenge to treat.
Some conservative treatments, including physical therapy, medications, and sympathetic nerve blocks, can be effective. But these options may fail to provide adequate results. Patients will often then consider neurostimulation to avoid more aggressive surgical alternatives.
Spinal Cord Stimulation (SCS) Therapy for CRPS
Traditional spinal cord stimulation (SCS) is a neurostimulation therapy used to manage chronic, severe pain. It has been in use for over 40 years.
Around the world, tens of thousands of patients undergo spinal cord stimulator implants each year. Spinal cord stimulation delivers mild electrical stimulation to nerves along the spinal column. This modifies nerve activity to minimize the sensation of pain signals reaching the brain.
SCS therapy is now significantly improved and refined since its first routine use. Advances have continued to enable better personalization and effectiveness for each patient’s needs.
However, chronic regional pain syndrome usually involves specific extremities such as the pelvis, groin, hip, knee, ankle, or foot. For some CRPS pain sufferers, spinal cord stimulation doesn’t provide the kind of specific extremity targeting needed for pain relief.
Dorsal Root Ganglion (DRG) Stimulation as an Alternative CRPS Therapy
Dorsal root ganglion (DRG) stimulation provides targeted neurostimulation pain relief to the lower extremities. The FDA has approved it for patients with complex regional pain syndrome (CRPS I and II). DRG stimulation has shown to be effective for CRPS when SCS isn’t a viable option.
It works by targeting neurostimulation at the dorsal root ganglion.
What Is a Dorsal Root Ganglion?
The nervous system in our bodies has two components: the central nervous system (CNS) and the peripheral nervous system (PNS). The central nervous system consists primarily of the brain and spinal cord. The peripheral nervous system consists of nerves and ganglia outside the brain and spinal cord.
For clarity, the definition of “ganglia” is the plural form of “ganglion.”
The peripheral nervous system’s job is to connect the central nervous system to the limbs and organs. It serves as a relay between the brain, spinal cord, and the rest of the body.
The dorsal root ganglia are clusters of neurons on the back root of spinal nerves. They act as peripheral nervous system “gates” controlling our perception. Everything we sense must pass through a dorsal root ganglion before entering the spinal cord. Those sensory signals then pass from spinal cord nerves to the brain.
How Does Dorsal Root Ganglion Stimulation Work?
Dorsal root ganglion stimulation is similar to traditional spinal cord stimulation. Both systems use a small neurostimulator implant pulse generator. And both use small, insulated wires called leads to direct stimulation to their targets.
The major difference between the two is the target. In spinal cord stimulation, the leads directly target spinal nerves. However, with dorsal root ganglion stimulation, the leads target dorsal root ganglia on the posterior root of spinal nerves.
When active, DRG stimulation delivers tiny electrical pulses to the dorsal root ganglia. These impulses mask the feeling of pain traveling to the brain.
The stimulator does not eliminate a patient’s pain but changes how their brain perceives it.
Why Is Dorsal Root Ganglion Stimulation More Effective for CRPS?
Spinal cord stimulation blocks pain signals from broad areas of the body.
In comparison, dorsal root ganglion stimulation is tightly focused on the nerves associated with a specific area of pain. This makes it more effective in masking pain from one particular extremity.
In addition, DRG requires only about 10% of the energy used by SCS, which minimizes the paresthesia-tingling sensation during use. It also means that the batteries of the system last far longer.
Procedural Perspective on DRG Stimulation
Dr. Jeffery Rowe is a physician at Main Line Spine, a physiatry specialized medical practice, who is an expert in the DRG procedure. Abbott notes that he has implanted more dorsal root ganglion stimulators than any other doctor in the United States. He is also one of the country’s top spinal cord stimulation physicians.
“I continue to see very encouraging results from DRG stimulation procedures,” says Dr. Rowe. “It has been a game-changer for treating chronic regional pain syndrome and other challenging conditions.”
Dr. Rowe has helped to train more than 2,000 doctors in the procedure at Abbott’s Texas facility. He was part of the Neuromodulation Appropriateness Consensus Committee (NACC) that developed the best practices consensus document on DRG stimulation.
“We see individuals who’ve had chronic pain for 20 years, and they think they’ve tried everything,’ says Dr. Rowe. “Or they may have had a spinal cord stimulation trial ten years ago. They’ll tell us that it didn’t help them much.”
“However, DRG stimulation provides a truly unique alternative. And neurostimulation has evolved significantly over the years,” he continued, “the technology is vastly different today. The differences over time are like comparing apples to oranges.”
Dr. Rowe reflected on what he believes is one of the major keys to success with the procedure. “It’s vital to devote enough time to place and anchor the leads properly,” he says. “It’s important to follow rigorous protocols to optimize lead placement.”
He encourages patients with CRPS who haven’t had success with conservative treatments to consider the procedure. Dr. Rowe says, “A DRG stimulation trial could be a first step to life with chronic pain in control.”
Dr. Rowe can be reached at (610) 337-3111, extension 123 (Main Line Spine – King of Prussia, PA).