Dorsal Root Ganglion Stimulation
Landmark study
A randomized controlled trial, the ACCURATE study (A Safety and Effectiveness Trial of Spinal Cord Stimulation of the Dorsal Root Ganglion for Chronic Lower Limb Pain) was launched in the US, leading to FDA approval in 2016. In this landmark study, DRG-S demonstrated superiority over standard neuromodulation therapy, spinal cord stimulation (SCS), in a head-to-head comparison for the treatment of chronic pain related to a nerve condition called complex regional pain syndrome (CRPS).1 Sub-analysis studies from this trial also showed that DRG-S provided better and more stable pain coverage to specific body regions such as the distal feet and legs than SCS. 2,3 Today, DRG-S is considered a front-line therapy for the treatment of chronic pain from specific body regions such as the lower back, groin, hip, knee, and foot.
Click to learn more about the treatment options
Low back and leg pain
Peripheral Neuropathy
Peripheral Vascular Disease and Cardiac
Abdominal and pelvic pain
Disorders of the sympathetic nervous system
The DRG-S Trial Procedure
After a patient decides to proceed with a DRG stimulator, there are several steps which must be completed. As with a traditional stimulator, there is first a 7-day trial period with the device. The leads are placed through the skin over the target levels. This trial period involves no incisions and the generator is taped to the skin on the outside of the body. An Apple device is provided to the patient and it is used to communicate with the device through an app. All patients are required to have a psychological clearance performed, a MRSA nasal swab, a medical clearance, among other paperwork. Click here for our pre-DRG-S Trial forms.
After the trial, you will return to the office and the leads are removed. The lead removal is a relatively benign and performed in the exam room. At that time, you will decide whether or not to proceed with the implant of the device.
Purpose of Study
The Dorsal Root Ganglion
As with SCS, electrical stimulation is provided by a battery-powered pulse generator connected to implanted lead wires placed approximate to the DRG structure. Depending on the location and area of pain, up to 4 leads may be placed at different spinal levels and/or on both sides of the spine to cover the painful region involved.
To learn more about DRG-S technology and the DRG-S trial and implant procedures, watch this video:
More on how DRG stimulation works
The placement of the electrical field at the DRG allows us to apply electrical energy to directly modulate pain fibers and also activate pain-relieving nerves to block pain.
From a basic science level, there are special characteristics about the DRG that makes it so appealing as a target. In the natural state, the DRG can serve as a ‘filter’ of sensory input. Thus, the DRG already serves as a ‘gatekeeper’ for sensation from the external environment, and our body, to the central nervous system. Applying stimulation to this site increases this filtering ability to decrease the amount of pain signals that pass through the gate in addition to other distinct mechanisms.
An additional effect of DRG-S is to activate nerve fiber lines as well. So, at the settings used, we can activate the nerve fibers that our body naturally has to block pain. This can be thought of as the way a pacemaker is able to make the heart beat at a certain rhythm. But rather than activating cardiac fibers, we are activating inhibitory fibers.
There are several types of sensory nerves. Aδ and C fibers are the smallest nerve fibers that transmit pain but are also responsible for sending light touch related sensations. These fibers surround our hair follicles and use endorphins as a messenger to transmit signals. Endorphins are inhibitory and act on our body’s opioid receptors to block pain. We currently have several research projects running to try to prove this is part of the mechanism of how DRG-S works.
DRG-S at The Spine and Pain Center of New York
The doctors at the Spine and Pain Institute of New York are considered thought leaders with dorsal root ganglion stimulation and have pioneered much of the research around the therapy. Our physicians have performed hundreds of DRG-S trial and implant procedures, among the most in the US and the world. This extensive experience has led to our physician’s role in the establishment of guidelines and treatment protocols with DRG-S.
Along with our extensive experience, we have a dedicated research team conducting studies in DRG-S to perfect the procedure technique and continue to improve the safety and efficacy of this therapy as well as expand its use in chronic pain treatment.
For a list of our study-related publications in peer-reviewed medical journals and conferences, and to learn more about ground-breaking research into DRG-S, please click here.
Our expertise in DRG-S has resulted in hundreds of success stories for our patients, many of whom have experienced near-miraculous improvements in their pain. Some of our patient testimonials to the success DRG-S therapy at SPNY can be found here.
With each success story and the variety of conditions we have been able to treat with DRG-S, we believe the potential uses for this therapy have only begun to scratch the surface. At SPNY, we take a more aggressive approach with DRG-S and consider it a front-line therapy for the treatment of chronic pain in many cases. If you are experiencing chronic pain that has failed conventional therapies, make an appointment today to meet with one of our DRG-S expert physicians to discuss if you are a candidate for this promising and exciting new therapy.
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Energy Delivered to the Neural Structures:
DRG-S uses far less electrical energy for effect when compared to other forms of spinal cord stimulation (SCS). Research performed by the physician researchers at the Spine & Pain Institute of NY on programming optimization have substantially reduced the amount of electricity delivered to the nerve tissue.
There are inherent anatomic and physiologic advantages to stimulation at the DRG rather than on the dorsal columns. Newer types of SCS have been introduced recently which have led to better outcomes, including Burst DR-SCS and High frequency SCS. With these systems, the leads are placed on the dorsal columns, but it is believed the effects are through alternative mechanisms potentially independent of the dorsal columns. These newer methods of SCS provide subthreshold stimulation, or in other words they do not require the tingling sensation to block pain sensation. Patients tend to prefer the subthreshold, paresthesia-free stimulation when compared to traditional, tonic SCS.1,3,4 When the electrical energy is delivered to the patient, it is not delivered in a constant manner. There are three parameters that can be manipulated:
The frequency measured in Hertz (Hz)- This is the number of times per second the electrical energy is activated.
The pulse width (pw)- This is how long each individual pulse is delivered for.
And, the amplitude measured in milliamps (mA)- This is the strength of the electrical energy.
The cumulative amount delivered to the patient is measured in a unit called microcouloumbs per second (uC/s) which is the product of frequency (Hz)*pulse width(pw)*amplitude (mA).5
Our research team performed studies demonstrating maintained efficacy with DRG-S at settings that were 4 times lower than previously reported. Additionally the SPNY team performed further research using cyclic ‘on’ ‘off’ paradigms to further decrease the necessary electrical charge to our nervous tissue by 2/3.6
Landmark study
A randomized controlled trial, the ACCURATE study (A Safety and Effectiveness Trial of Spinal Cord Stimulation of the Dorsal Root Ganglion for Chronic Lower Limb Pain) was launched in the US, leading to FDA approval in 2016. In this landmark study, DRG-S demonstrated superiority over standard neuromodulation therapy, spinal cord stimulation (SCS), in a head-to-head comparison for the treatment of chronic pain related to a nerve condition called complex regional pain syndrome (CRPS).1 Sub-analysis studies from this trial also showed that DRG-S provided better and more stable pain coverage to specific body regions such as the distal feet and legs than SCS. 2,3 Today, DRG-S is considered a front-line therapy for the treatment of chronic pain from specific body regions such as the lower back, groin, hip, knee, and foot.
Click to learn more about the treatment options
Low back and leg pain
Peripheral Neuropathy
Peripheral Vascular Disease and Cardiac
Abdominal and pelvic pain
Disorders of the sympathetic nervous system
The DRG-S Trial Procedure
After a patient decides to proceed with a DRG stimulator, there are several steps which must be completed. As with a traditional stimulator, there is first a 7-day trial period with the device. The leads are placed through the skin over the target levels. This trial period involves no incisions and the generator is taped to the skin on the outside of the body. An Apple device is provided to the patient and it is used to communicate with the device through an app. All patients are required to have a psychological clearance performed, a MRSA nasal swab, a medical clearance, among other paperwork. Click here for our pre-DRG-S Trial forms.
After the trial, you will return to the office and the leads are removed. The lead removal is a relatively benign and performed in the exam room. At that time, you will decide whether or not to proceed with the implant of the device.
Funding for study
This research is made possible through an grant from Abbott Neuromodulation.
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