scholarly journals P.152 Efficacy of Dorsal Root Ganglion Stimulation for Post Surgical Neuropathic Pain

2021 ◽  
Vol 48 (s3) ◽  
pp. S63-S63
Author(s):  
R Sahjpaul ◽  
V Varshney ◽  
J Osborn
Keyword(s):  
Neuropathic Pain ◽  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Pain Syndrome ◽  
Patient Reported Outcome Measures ◽  
Effective Treatment Option ◽  
Point Change ◽  
Patient Reported

Background: The dorsal root ganglion (DRG) has been established as an important structure in the development and modulation of chonic neuropathic pain and has demonstrated superiority over spinal cord stimulation in the management of challenging neuropathic pain conditions, including complex regional pain syndrome and chronic post-spine surgery neuropathic pain. DRG has only been available in Canada for patient application since January 2020. The St Pauls Hospital Neuromodulation Program was one of the first Canadian centers to offer this procedure. Methods: We reviewed our early experience with DRG therapy in 10 patients. Patient-reported outcome measures were collected pre-trial, post-trial, and post-device implantation, to determine the efficacy of DRG. We hypothesized that DRG stimulation would demonstrate a meaningful change in PROMIS-29 domains and at least 50% improvement in pain intensity at 8 wks. Results: All patients demonstrated a > 5 point change in T scores in PROMIS-29 domains suggesting a meaningful benefit. Patients also demonstrated a percentage pain improvement at 8 wks of 64 % based on a numerical rating scale. No major complications were observed. Conclusions: DRG stimulation is a safe and effective treatment option for neuropathic pain.

scholarly journals Effectiveness of “Transgrade” Epidural Technique for Dorsal Root Ganglion Stimulation. A Retrospective, Single-Center, Case Series for Chronic Focal Neuropathic Pain

2019 ◽  
Vol 6 (22;6) ◽  
pp. 601-611
Author(s):  
Adnan Al-Kaisy
Keyword(s):  
Neuropathic Pain ◽  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Rating Scale ◽  
Small Sample Size ◽  
Case Series ◽  
Implantation Rate ◽  
Pain Syndrome ◽  
Small Sample ◽  
Electrode Placement

Background: The recent interest in targeting the dorsal root ganglion (DRG) has led to the development of new techniques of electrode placement. In this article, we describe a new “Transgrade” approach to the DRG, accessing the contralateral interlaminar space and steering the lead out the opposite foramen. Objectives: The purpose of this study was to evaluate the Transgrade technique to the DRG in the management of focal neuropathic pain, predominately complex regional pain syndrome in terms of efficacy and safety. Study Design: A retrospective, observational review of all patients selected for DRG stimulation using the Transgrade technique to the DRG. Setting: Pain Management and Neuromodulation Centre, Guys and St. Thomas NHS Foundation Trust, London, United Kingdom. Methods: Data were taken from a hospital password-protected database. All patients were contacted by telephone for Numeric Rating Scale (NRS-11) score, Patient Global Impression of Change (PGIC) score, and complications. A patient responder was defined as having a PGIC score of 6 or 7, and a 2-point reduction from baseline NRS-11. Results: A total of 39 patients (46% women) with a mean age of 46 years (± 2) underwent a trial of DRG stimulation that resulted in an implantation rate of 82% (32 of 39). The responder rates, according to NRS-11 and PGIC results, were 87% (28 of 32) at 6 weeks and 66% (21 of 32) at a mean of 18 months (± 1.8) follow-up. Pocket pain was the most common complication, occurring in 7 of 32 (22%) patients, and the lead migration rate was 3 out of 57 leads placed (5.2%). A burst protocol was the favored method of stimulation in the majority of patients, 25 of 32 (78%). Limitations: Retrospective nature of design, small sample size. Conclusions: The Transgrade technique of placing DRG leads offers an alternative method that is safe and effective. New methods of stimulation to the DRG offer more choice and potentially better efficacy for patients with chronic neuropathic pain.

scholarly journals 8% Capsaicin Patch in Treatment of Peripheral Neuropathic Pain

2020 ◽  
Vol 5;23 (9;5) ◽  
pp. E541-E548
Author(s):  
Décia Gonçalves
Keyword(s):  
Neuropathic Pain ◽  
Pain Intensity ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Pain Syndrome ◽  
Peripheral Neuropathic Pain ◽  
Patch Application ◽  
Analgesic Therapy ◽  
Number Of Patients ◽  
Painful Area

Background: Neuropathic pain is a complex condition that is difficult to control and has a high impact on quality of life. 8% Capsaicin patch can be a therapeutic strategy in the treatment of peripheral neuropathic pain. Objectives: This study aims to (1) evaluate clinical efficacy and (2) tolerability of 8% capsaicin patch in a Pain Unit. Study Design: Retrospective observational study Setting: Portuguese Pain Unit Methods: A sample of 120 patients diagnosed with peripheral neuropathic pain, underwent treatment with the 8% capsaicin patch between February 2011 and February 2019 in a Portuguese Pain Unit. Patients were included in one of the following groups according to the etiology of pain: postherpetic neuralgia (PHN), chronic post-surgical pain (CPSP), post traumatic neuropathic pain (PTNP), diabetic neuropathy (DN), regional pain syndrome. complex I and II (CRPS I / II), HIVassociated neuropathy (HIVN), lumbar neuropathic pain (LNP), trigeminal neuralgia (TN) and other neuropathies (O). The evaluated parameters were: pain intensity according to unit protocol (numerical rating scale), pain characteristics, location, size of the painful area. The evolution of pain intensity after treatment (patients were considered as responders to therapy if the decrease in NRS was equal to or greater than 30%; patients with a decrease in NRS of 50% or more were also analyzed), the area of pain and the need for adjuvant analgesic therapy, as well as the tolerability to treatment and the identification of eventual predictors of its efficacy were evaluated, at 15 days, 8 weeks and 12 weeks after 8% capsaicin patch. Results: Of the 120 patients in the sample, 40.8% had a ≥ 30% decrease in basal pain intensity 15 days after treatment, 43.3% after 8 weeks and 45.0% after 12 weeks. 30.8% of patients had ≥ 50% decreased basal pain intensity 15 days after treatment, 27.5% after 8 weeks and 30.0% after 12 weeks. Pain area decreased in 36.7% of patients and 18.3% reduced chronic analgesic therapy within 12 weeks after 8% capsaicin patch application. There was only one case of intolerance to the treatment. Limitations: This study has the limitations inherent to a retrospective study. The study period was only 12 weeks and some diagnostic groups included a small number of patients. Conclusion: Treatment of peripheral neuropathic pain with 8% capsaicin patch seem to be effective in the short and medium term, both in decreasing pain intensity and in reducing the painful area. Its application is tolerated by most patients. Key words: 8% capsaicin patch, peripheral neuropathic pain, pain intensity, painful area

scholarly journals Effectiveness of Pulsed Radiofrequency with Multifunctional Epidural Electrode in Chronic Lumbosacral Radicular Pain with Neuropathic Features

2014 ◽  
Vol 6;17 (6;12) ◽  
pp. 477-486 ◽  
Author(s):  
Simone Vigneri
Keyword(s):  
Neuropathic Pain ◽  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Rating Scale ◽  
Radicular Pain ◽  
Pain Intensity Score ◽  
Pulsed Radiofrequency ◽  
Number Of Patients ◽  
Pre Treatment

Background: Lumbosacral radicular pain is a common clinical finding with a statistical prevalence ranging from 9.9% to 25% in the general population. Objective: To investigate the effectiveness of dorsal root ganglion pulsed radiofrequency (PRF) in patients with chronic lumbosacral radicular pain and neuropathic features. Study Design: Prospective case series clinical outcome study. Methods: We evaluated 34 patients with lumbosacral neuropathic pain who underwent PRF at the corresponding level of radicular symptoms distribution (ranging from L3 to S1). Each patient suffered a single leg-radiating pain with probable neuropathic features (assessed with clinical grading) lasting for > 6 months and unresponsive to previous treatments. A multifunctional PASHA-electrode® was introduced with trans-sacral access through a hollow needle, placed under fluoroscopic guidance into the lumbosacral epidural space and its active tip moved close to the dorsal root ganglion responsible of the clinical symptoms. After connecting the electrode to a generator, stimulation tests were performed and PRF was started and applied for 240 seconds at a frequency of 2Hz, amplitude of 45 V and a tip temperature between 40 – 42°C. If the pain involved more than a single nerve root, the electrode was placed at a different segment and the procedure repeated. Outcome measures included the pain intensity score on a 0 – 10 numeric rating scale (NRS) and the Italian Pain Questionnaire (QUID) at pre-treatment, one and 6 months post-treatment. P values < 0.05 were considered statistically significant. Results: In comparison with pre-treatment, a significant reduction in pain score was observed in mean NRS either at one and 6 months (P < 0.001). The QUID - Pain Rating Index rank displayed a parallel trend at the first (P < 0.001) and last follow-up (P = 0.01). Moreover, a direct correlation between the 2 scales occurred, showing a parallel score decreasing (P < 0.001). Eighteen (52.9%) and 17 (50%) of 34 patients showed pain reduction in NRS > 2 points and > 30%, at one and 6 months, respectively. Limitations: The non-controlled design of the study, the patients were heterogeneous, the small number of patients, and the duration of follow-up was limited to 6 months. Conclusions: PRF of dorsal root ganglion performed with a multifunctional electrode for > 240 seconds appears to be safe and might be more effective than the classic 120 seconds needlemediated approach. Therefore, it may be considered as a valuable tool for the treatment of lumbosacral radicular pain with neuropathic features. Key words: PRF, radicular pain, neuropathic pain, DRG, NRS, PRIr-T, multifunctional electrode

scholarly journals Pulsed Radiofrequency Dorsal Root Ganglion-Fluoroscopy Guide for Lumbar Radicular Pain

2021 ◽  
Vol 2 (2) ◽  
pp. 82-88
Author(s):  
Nugroho Wicaksono ◽  
Keyword(s):  
Neuropathic Pain ◽  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Rating Scale ◽  
Positive Outcome ◽  
Radicular Pain ◽  
Pulsed Radiofrequency ◽  
Post Intervention ◽  
Disc Protrusion ◽  
Lumbar Radicular Pain

Background: Lumbosacral radicular pain is the most common neuropathic pain. Pulsed Radio Frequency (PRF) is a method that believes to be safe and effective for reducing pain. Case: A 43-year-old woman experiences chronic right lumbar radiculopathy due to Herniated nucleus pulposus (HNP) L4-5. Anamnesis and physical examination show a sign of neuropathic pain. The MRI examination shows a paracentral disc protrusion L4-5 that compresses the transversing nerve L5. The conservative management did not produce a satisfying result indicated by the patient still experience pain with the Numeric Rating Scale (NRS) 4-5. Patient unable to do activity properly. We perform pain management using the dorsal root ganglion L5 pulsed radiofrequency-fluoroscopy (PRF) and producing a positive outcome. Patients experience a decrease in pain intensity with NRS 1. The examination on one and two months post-intervention show an improvement. Patient able to do the daily activity with NRS 1-2. Conclusion: Pulsed radiofrequency dorsal root ganglion-fluoroscopy guide that relatively safe, minimum complications, and minimal side effects, making it the preferred treatment for chronic lumbar radicular pain.

scholarly journals Efficacious Dorsal Root Ganglion Stimulation for Painful Small Fiber Neuropathy: A Case Report

2017 ◽  
Vol 3 (20;3) ◽  
pp. E459-E463 ◽  
Author(s):  
Eva Koetsier
Keyword(s):  
Neuropathic Pain ◽  
Case Report ◽  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Rating Scale ◽  
Pain Treatment ◽  
Small Fiber Neuropathy ◽  
Intractable Pain ◽  
Positive Trial ◽  
Small Fiber

Small fiber neuropathy is a disorder of the peripheral nerves with typical symptoms of burning, sharp, and shooting pain and sensory disturbances in the feet. Pain treatment depends principally on the underlying etiology with concurrent administration of antidepressants, anticonvulsants, opioids, and topical treatments like capsaicin and local anesthetics. However, treatments for pain relief in these patients frequently fail. We describe the first case of intractable painful small fiber neuropathy of the foot successfully treated with spinal cord stimulation of the left L5 dorsal root ganglion. A 74-year-old man presented at our clinic with severe intractable pain, dysesthesia, and allodynia of the left foot caused by idiopathic small fiber neuropathy, confirmed by skin biopsy. His pain score was 8 on a standard 0 – 10 numeric rating scale. As the pain was not satisfactorily controlled by conventional therapy, dorsal root ganglion stimulation was proposed to the patient and, after informed consent, a specifically designed percutaneous stimulation lead was placed over the left L5 dorsal root ganglion and connected to an external neurostimulator. After a positive trial of 10 days, a permanent neurostimulator was implanted. Twenty months post-implantation the patient continued to experience stimulation-induced paresthesia covering the entire pain area and reported a pain rating of 4. Results from the case report demonstrate that the dorsal root ganglion is a promising neural stimulation target to treat neuropathic pain due to intractable small fiber neuropathy. Prospective controlled studies are warranted to confirm the efficacy of this treatment as an option for the aforementioned condition. Key words: Dorsal root ganglion stimulation, small fiber neuropathy, neuropathic pain

scholarly journals Differential response to scrambler therapy by neuropathic pain phenotypes

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Young Gi Min ◽  
Hyun Seok Baek ◽  
Kyoung-Min Lee ◽  
Yoon-Ho Hong
Keyword(s):  
Neuropathic Pain ◽  
Treatment Outcome ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Brief Pain Inventory ◽  
Differential Response ◽  
Open Label ◽  
Numerical Rating ◽  
Scrambler Therapy ◽  
Post Hoc

AbstractScrambler therapy is a noninvasive electroanalgesia technique designed to remodulate the pain system. Despite growing evidence of its efficacy in patients with neuropathic pain, little is known about the clinical factors associated with treatment outcome. We conducted a prospective, open-label, single-arm trial to assess the efficacy and safety of scrambler therapy in patients with chronic neuropathic pain of various etiologies. A post-hoc analysis was performed to investigate whether cluster analysis of the Neuropathic Pain Symptom Inventory (NPSI) profiles could identify a subgroup of patients regarding neuropathic pain phenotype and treatment outcome. Scrambler therapy resulted in a significant decrease in the pain numerical rating scale (NRS) score over 2 weeks of treatment (least squares mean of percentage change from baseline, − 15%; 95% CI − 28% to − 2.4%; p < 0.001). The mean score of Brief Pain Inventory (BPI) interference subdimension was also significantly improved (p = 0.022), while the BPI pain composite score was not. Hierarchical clustering based on the NPSI profiles partitioned the patients into 3 clusters with distinct neuropathic pain phenotypes. Linear mixed-effects model analyses revealed differential response to scrambler therapy across clusters (p = 0.003, pain NRS; p = 0.072, BPI interference subdimension). Treatment response to scrambler therapy appears different depending on the neuropathic pain phenotypes, with more favorable outcomes in patients with preferentially paroxysmal pain rather than persistent pain. Further studies are warranted to confirm that capturing neuropathic pain phenotypes can optimize the use of scrambler therapy.

Role of TRPV4-P2X7 Pathway in Neuropathic Pain in Rats with Chronic Compression of the Dorsal Root Ganglion

2021 ◽  
Author(s):  
Xiaohua Fan ◽  
Chuanwei Wang ◽  
Junting Han ◽  
Xinli Ding ◽  
Shaocan Tang ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Dorsal Root Ganglion ◽  
Dorsal Root

A Prospective Analysis of Neuromonitoring for Confirmation of Lead Placement in Dorsal Root Ganglion Stimulation

2017 ◽  
Vol 14 (6) ◽  
pp. 654-660 ◽  
Author(s):  
Steven M Falowski ◽  
Andreas Dianna
Keyword(s):  
Neuropathic Pain ◽  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Evoked Potential ◽  
Somatosensory Evoked Potential ◽  
Prospective Analysis ◽  
Awake Patient ◽  
Chronic Neuropathic Pain ◽  
Lead Placement

Abstract BACKGROUND Dorsal root ganglion stimulation is a neuromodulation therapy used for chronic neuropathic pain. Typically, patients are awakened intraoperatively to confirm adequate placement. OBJECTIVE To determine whether neuromonitoring can confirm placement in an asleep patient. METHODS This is a prospective analysis of 12 leads placed in 6 patients. Lead confirmation was confirmed by awake intraoperative testing, as well as asleep testing utilizing neuromonitoring. Patients were used as their own control. Sensory and motor thresholds for each patient with awake and asleep neuromonitoring testing were recorded. Intraoperative impedance and postoperative programming were also recorded. RESULTS In each patient, paresthesias were generated prior to motor contractions in the awake patient. For each patient, somatosensory evoked potential responses were present after lowering below the dropout threshold of electromyogram responses with neuromonitoring. There were varying degrees of separation in the thresholds that did not appear to be consistent across level or diagnosis. Smaller degrees of separation between thresholds during awake testing also held true in the asleep patient. This was further confirmed with postoperative programming. Impedances did not alter the separation in thresholds or amount of stimulation required for responses. One patient was combative during awake testing, and therefore motor thresholds were not obtained. This same patient was determined to have a ventral placement, confirmed with awake and asleep neuromonitoring testing. CONCLUSION This series demonstrates that the proposed neuromonitoring protocol can be used in an asleep patient to assure proper positioning of the dorsal root ganglion electrode in the dorsal foramen by generating somatosensory evoked potential responses in the absence of electromyogram responses.

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