What is Dorsal Root Ganglion Stimulation?
Dorsal root ganglion stimulation (DRG-S) is a form of neuromodulation where an electrical field is placed over the DRG and was designed to meet some of the shortcomings with SCS. The dorsal root ganglion (DRG) is a cluster of cell bodies of the nerves that travel from the extremities into the brain. This collection of cell bodies forms a bulge within the nerve just before or as it enters the spinal canal. The cell bodies can be looked at as the processing units of the nerves.
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By stimulating at the DRG we are able to interrupt pain signals before they reach the spinal cord or brain, so you don't feel pain in the same way. Interrupting these pain signals at the source enables the use of low energy levels and helps eliminate unnecessary stimulation throughout the body.
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DRG Stimulation has demonstrated superior pain relief when compared to traditional SCS for treating Complex Regional Pain Syndrome (CRPS) and post-surgical nerve pain in the ACCURATE randomized controlled trial.
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The DRG serves as a ‘gatekeeper’ for sensations coming from the external environment, as well as from our own body to the central nervous system. The placement of the electrical field at the DRG allows us to modulate the pain messages being transmitted to the spinal cord, and also activate pain-relieving nerves to actually block pain.
Dr. Ken Chapman
What is Dorsal Root Ganglion Stimulation?
In essence, we are activating 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.
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The 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.
Shortcomings of Spinal Cord Stimulation
Stimulating these fibers causes a constant tingling sensation known as a paresthesia in the region of the body that the fibers are transmitting sensation from. By creating a paresthesia in a painful area, pain signaling can be masked and reduced, leading to pain relief.
While this was the earliest form of neuromodulation used to treat chronic pain, it had its shortcomings. First, most patients are not comfortable with the constant tingling sensation SCS creates. Second, tolerance to the stimulation builds over time with loss of efficacy within 1-3 years in many cases. As a result, newer forms of paresthesia-free SCS were introduced with better results, including Burst DR-SCS and High frequency SCS. However, limitations in pain coverage and efficacy with certain conditions like axial low back pain and joint pain remain.
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More on Dorsal Root Ganglion Stimulation
These brochures are distributed by Abbott Neuromodulation, the manufacturer of the system utilized in this study. The Abbott Proclaim IPG was FDA approved in 2016 for complex regional pain syndrome types I and II.