Our Research
The Spine & Pain Institute of NY has been dedicated not only to excellence in patient care, but also in the promotion of education and research in the field of pain management.
The research department is funded by the non-for profit SPNY Foundation. The foundation's primary goal is the promotion of non-industry biased research for the betterment of patient care and outcomes.
Below are some of our published research articles.
T12 DRG-S for Chronic Low Back Pain: A Case Series
This paper was the first documenting the placement of DRG stimulation at the T12 level for low back pain.
Intermittent DRG-S is as Efficacious as Standard Continuous Dosing: Results from a Randomized Controlled Feasibility Trial
After identifying the ability of DRG-S to function at these low frequency settings, we next studied the ability of DRG-S to function when turned on intermittently.
We identified the fact that having the stimulator on continuoulsly had the same effects as having the stimulation cycle 'on' for one minute and 'off' for up to 2 minutes.
The Pathways and Processes Underlying Spinal Transmission of Low Back Pain: Observations from DRG-S Treatment
Our team performed an in depth analysis on why DRG-S at T12 could have such profound results for treating low back pain.
This paper not only outlines the underlying mechanisms of DRG-S placed at T12 but also the possible manner in which low back pain is transmitted to the brain.
This article was selected as an 'Editor's Choice' article in Neuromodulation, the top-rated journal in the field. See below.
Very Low Frequencies Maintain Pain Relief from DRG-S: An evaluation of frequency tapering
This study brought to light the ability of DRG-S to function efficaciously at the lowest possible setting of the stimulator device. Frequencies of the stimulation were titrated to 4 Hz. This very low level of stimulation leads to a significantly decreased amount of electricity delivered to neural tissue.
Mechanisms for the Clinical Utility of Low-Frequency Stimulation in Neuromodulation of the DRG.
This paper is a review of literature on the effects of frequency on nerve fiber types and the result clinical outcomes from low frequency stimulation.
This paper along with the others works underscore the role of specific frequencies activating particular nerve fiber types.
Lead Migration and Fracture Rate in DRG-S using anchoring and non-anchoring techniques: A Multicenter pooled data analysis
Our team pooled data to better understand potential complications of DRG-S and found that the top two complications could be reduced to very low levels simply by the placement of an anchor on the lead. This common sense solution has changed the manner in which this procedure is performed.
How DRG-S at T12 for Low Back Pain Reveals the Transmission of Low Back Pain in the Spinal Cord
We created an illustrative depiction of the Pathways and Processes of DRG-S at T12 listed above. Investigating the potential mechanisms of this therapy also elucidates the transmission of pain in the low back to the brain.
Publications Related to
Mechanism of Action
Our physicians appreciated that the outcomes of DRG-S differed significantly from spinal cord stimulation and decided to research its potential underlying mechanisms. Our first letter to the Editor in 2018, we posed the question, should we be looking at alternative mechanisms of action than SCS, given we are stimulating an alternative target. The team then researched how T12 DRG stimulation could cause such a dense inhibition of pain from the diffusely innervated low back through a review of relevant research from across all fields.
Multiple findings came from this work. The most significant was the conclusion that in order to achieve back pain relief by stimulating at the T12 DRG, there must be a point of convergence to allow this single dermatome to inhibit multi-dermatomal pain. In turn, we believe this reveals how low back pain was transmitted within the spinal cord itself.
It also suggested that activation of the endogenous opioid system is activated with DRG-S. This led to us to study ultralow frequency stimulation and intermittent dosing of the electrical stimulation, both characteristics associated with the endogenous opioid system.
Our article 'The Pathways and Processes Underlying Spinal Transmission of Low Back Pain: Observations from DRG-S Treatment' was selected as Editor's Choice by the journal Neuromodulation. The artwork also was used for the cover of the journal for that month.
This article explains why we believe placing the DRG stimulator at the level of T12 works for such severe low back pain.
Hear Dr. Chapman being interviewed by Paincast regarding the use of DRG-S for chronic low back pain!
Publications Related to
Procedural Techniques
Our team has published multiple articles on different approaches, not just for DRG stimulation, but also for radiofrequency ablation, which is another commonly performed procedure. Having some of the most experience in the world with DRG stimulation allows us to have used multiple approaches for placing these devices, when the traditional manner is not available.
We also published the new technique for placement which was designed to decrease lead fracture and migration rates for the therapy.
Publications Related to
Consensus Statements
and Guidleines
Our team has been involved in the authoring of multiple guidelines involving neuromodulation.
Publications Relating to Abdominal and
Pelvic Pain
Publications Relating to Practice Improvement
Our team has pioneered several clinical practices that are used across the field. Here you can see publications involving a computer program we designed to identify patients on opioids who required a urine toxicology test. Additionally, we were one of the first to report on the impact of remote programming with neuromodulation. A true revolution in the treatment of patients with implantable therapies for pain.
Publications Related to
Peripheral Neuropathy and Case Reports
Dorsal root ganglion stimulation for peripheral neuropathy is considered an 'off label' application of the therapy. Here we published case reports regarding its use and potential benefits.
Publications Related to
Complication Mitigation
Understanding the potential benefits of this therapy, our team had focused on improving the manner in which the treatment is applied. We believe that DRG-S has the potential to solve many of the shortcomings of scs, and our goal is to help make this therapy as safe and effective as possible.
This newer therapy has undergone several of the same struggles that spinal cord stimulation had undergone. Our team took the initiative to gather and analyze data on these complications and discovered common sense solutions to decrease complication rates.
Dorsal Root Ganglion Stimulation Device Explantation:
A multicenter pooled Data Analysis
In the pooling data of 4 major centers utilizing DRG-S, it was revealed that simply placing an anchor decreased the migration risk to ~1% per lead and likely will reduce fracture rates. In gathering this data, other interesting findings were also revelated.
Of these 249 patients who were implanted for an average of 27 months, there were only 10 patients who had their devices removed for any reason, and there was only 1 infection. This is a rate of therapy exit of XXX and an infection rate of 0.4%. These numbers support previous work by Levy et al. (1) which demonstrates that patients who are implanted with DRG-S continue to have good, maintained results over time that were superior to those seen with spinal cord stimulation.
Levy RM, Mekhail N, Kramer J, et al. Therapy Habituation at 12 Months: Spinal Cord Stimulation Versus Dorsal Root Ganglion Stimulation for Complex Regional Pain Syndrome Type I and II. J Pain. 2020;21(3-4):399-408. doi:10.1016/j.jpain.2019.08.005
Publications Related to
Indication Expansion
Our team is currently working on a number of studies regarding the application of DRG stimulation for new conditions.
Peripheral vascular disease and peripheral neuropathy are two conditions that we are also actively studying. Here you can see dramatic improvements in patients suffering from peripheral vascular disease as well as a severe form of Raynaud's syndrome.
These conditions are involved with the small nerve fibers that DRG stimulation has the ability likely to be superior to traditional spinal cord stimulation.
Response articles
Several papers have been published regarding DRG stimulation which our team felt cast an unfair light on the therapy. Two of the responses to the journal editors that we wrote were published here.