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What is dorsal root ganglion stimulation?

Dorsal root ganglions are bundles of nerves in the spine that transmit sensory and pain signals to the brain. Dorsal root ganglion stimulation(DRGS) involves placing tiny wires called electrodes near these nerve bundles. The electrodes are connected to an electrical device, or ‘pulse generator’, that sends out electrical impulses to alter pain signals to the brain.

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What is it used to treat?

Dorsal root ganglion stimulation is used to treat neuropathic (nerve-related) pain. It is useful in treating chronic pain (persistent pain that carries on for longer than 12 weeks despite medication or treatment), particularly in areas that are hard to target using traditional spinal cord stimulation (SCS) techniques, such as the groin and foot.

So far, dorsal root ganglion stimulation has been found to be a novel, safe, and effective way of treating the following types of pain:

Chronic Regional Pain Syndrome

This condition is defined by pain that is out of proportion to the underlying injury. It usually affects one limb (arm, leg, hand or foot) and is divided into two types: type 1 is defined as pain without nerve injury, and type 2 as pain with nerve injury.

Phantom limb pain

This is a common condition that arises after amputation of a limb or part of that limb, where patients feel pain in the part that no longer exists. It is thought that phantom limb pain occurs in 40-80% of patients after amputation surgery, and it can be a challenging condition to treat.

Other conditions

Other types of neuropathic pain that can be effectively treated with dorsal root ganglion stimulation include groin pain, which typically arises from a previous surgery such as a hernia repair (with or without mesh insertion), genital pain, and peripheral nerve injury following surgery such as kidney surgery or joint replacement.

How is it performed and what is involved?

DRGS systems need to be put in place by surgery, through the skin of the back. There are two main types of systems – a temporary system where the electrical device is located outside the body, and a more permanent system where the device is located inside the body. The temporary system is used as a trial to assess how effective the treatment is for the patient and to identify where best to place the electrodes. If the trial is a success, then a further procedure will be performed to implant the permanent device under the skin.

Only small amounts of energy are needed to alter pain signals in the dorsal root ganglion, so devices can usually keep working on a limited battery supply.

What are the risks?

Dorsal root ganglion stimulation is considered to be effective and safe. However, as with any procedure there are always some risks to consider:

Device-related risks

The most common side effects that occur with the placement of a dorsal root ganglion stimulation system are non-life threatening and are largely due to device-related issues. These include:

  • Discomfort at the insertion site
  • Failure of the device or inactivation
  • Breakage of the electrode(s)
  • Migration of the electrode(s) from the intended location.

 

Biological risks

Rarely, biological risks can arise, and these include:

  • A very small risk of an infection at the site of insertion
  • Post-operative headache due to leakage of fluid in the spinal canal (called cerebrospinal fluid)
  • Haematoma (collection of blood) that can cause pressure on the spinal cord and very rarely, paralysis.

Only small amounts of energy are needed to alter pain signals in the dorsal root ganglion, so devices can usually keep working on a limited battery supply.

How effective is it?

Dorsal root ganglion stimulation has been proven to successfully treat chronic intractable pain (persisting pain that doesn’t respond to conventional treatments). It has been reported that over 80% of patients treated with dorsal root ganglion stimulation have a reduction of their pain which is clinically measured as a 50% or greater improvement in pain levels.

Dorsal root ganglion stimulation is most effective at treating localised areas of pain, particularly in the leg and foot, with up to 80% reduction in foot pain.

As well as improving pain control, dorsal root ganglion stimulation has also been found to improve mood and quality of life.

Why choose The London Clinic?

Here at The London Clinic, we offer access to leading specialists in the field of neuromodulation, the very best facilities and equipment, and clinical support teams that are second to none. Our multidisciplinary team are experienced in working closely together to support each patient through their dorsal root ganglion stimulation treatment and recovery.

What the experts say...

Dorsal root ganglion stimulation is best for pain affecting one area of the body or body part. We are involved in clinical trials of it for novel indications such as diabetic foot pain, as well as using it for established indications such as pain after hernia repair, knee replacement, amputation or CRPS.

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