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Dorsal root ganglion stimulation for the treatment of joint pain with predominantly nociceptive characteristics: A case series.

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Title: Dorsal root ganglion stimulation for the treatment of joint pain with predominantly nociceptive characteristics: A case series.
Authors: Chapman, Kenneth B., Tupper, Connor, Vissers, Kris C., van Helmond, Noud, Yousef, Tariq
Source: Pain Practice. Mar2023, Vol. 23 Issue 3, p317-324. 8p. 1 Black and White Photograph, 1 Chart, 1 Graph.
Subjects: Postoperative pain treatment, Chronic pain treatment, Knee joint, Lumbar pain, Spinal cord, Knee osteoarthritis, Pain measurement, Hip osteoarthritis, Total hip replacement, Total knee replacement, Ankle joint, Hip joint, Arthroscopy, Sensory ganglia, Retrospective studies, Acquisition of data, Severity of illness index, Treatment failure, Causalgia, Electric stimulation, Case studies, Questionnaires, Disabilities, Medical records, Complex regional pain syndromes, Pain management, Nociceptive pain, Neural stimulation, Total ankle replacement, Failed back surgery syndrome, Innervation
Abstract: Introduction: Dorsal root ganglion stimulation (DRG‐S) has recently emerged as a novel therapy in neuromodulation that demonstrated a higher rate of success than spinal cord stimulation (SCS) in a prospective, head‐to‐head randomized comparative trial to treat complex regional pain syndrome (CRPS) and causalgia. In contrast to SCS, DRG‐S also shows promise in treating conditions that are not purely neuropathic such as axial low back pain, which has a prominent nociplastic pain component. It is not known to what extent the effectiveness of DRG‐S for such indications is due to effective treatment of the neuropathic pain component versus the effects of DRG‐S on mechanical pain. Although rarely studied, reporting outcomes of DRG‐S to treat predominantly mechanical/nociceptive pain may help point toward expanding the utility of this therapy. Here, we present five cases of refractory mechanical pain treated with DRG‐S. Methods: A retrospective analysis of all patients who underwent a successful DRG‐S trial and implant between September 2017 and September 2021 at our institute was performed. Patients who had intractable joint pain without strong evidence of neuropathic pain were included in this case series. The Budapest criteria for CRPS, the Douleur Neuropathique 4 Questions (DN4) survey, or a definable nerve injury were used to determine the presence of neuropathic pain. Baseline assessments for pain (Numeric Rating Scale [NRS]), function (Oswestry Disability Index [ODI]), quality of life (EuroQol‐5 Dimension [EQ‐5D]), and other applicable joint surveys were extracted from pre‐trial baseline and follow‐up appointments. Results: Five patients were identified and included. Patient diagnoses consisted of refractory joint pain of the hip, knee, or ankle. Mean NRS pain scores improved by 74% from 9.2 at baseline to 2.4 at the last follow‐up (mean = 28 months post‐implant). From baseline to the last follow‐up, mean ODI scores improved by 65% from 66 to 23 and EQ‐5D scores more than doubled from an average of 0.371 to 0.797. Conclusion: This clinical report illustrates the potential utility DRG‐S has in treating pain that clinically presents as predominantly refractory mechanical joint pain without a significant neuropathic component. The physiological reasons for our observations may be that DRG‐S is able to directly influence the conduction of nociceptive signaling at the DRG and within the spinal cord. Further investigations are warranted to determine if DRG‐S is a potential treatment option for chronic mechanical pain. [ABSTRACT FROM AUTHOR]
Copyright of Pain Practice is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Dorsal root ganglion stimulation for the treatment of joint pain with predominantly nociceptive characteristics: A case series.
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– Name: Abstract
  Label: Abstract
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  Data: Introduction: Dorsal root ganglion stimulation (DRG‐S) has recently emerged as a novel therapy in neuromodulation that demonstrated a higher rate of success than spinal cord stimulation (SCS) in a prospective, head‐to‐head randomized comparative trial to treat complex regional pain syndrome (CRPS) and causalgia. In contrast to SCS, DRG‐S also shows promise in treating conditions that are not purely neuropathic such as axial low back pain, which has a prominent nociplastic pain component. It is not known to what extent the effectiveness of DRG‐S for such indications is due to effective treatment of the neuropathic pain component versus the effects of DRG‐S on mechanical pain. Although rarely studied, reporting outcomes of DRG‐S to treat predominantly mechanical/nociceptive pain may help point toward expanding the utility of this therapy. Here, we present five cases of refractory mechanical pain treated with DRG‐S. Methods: A retrospective analysis of all patients who underwent a successful DRG‐S trial and implant between September 2017 and September 2021 at our institute was performed. Patients who had intractable joint pain without strong evidence of neuropathic pain were included in this case series. The Budapest criteria for CRPS, the Douleur Neuropathique 4 Questions (DN4) survey, or a definable nerve injury were used to determine the presence of neuropathic pain. Baseline assessments for pain (Numeric Rating Scale [NRS]), function (Oswestry Disability Index [ODI]), quality of life (EuroQol‐5 Dimension [EQ‐5D]), and other applicable joint surveys were extracted from pre‐trial baseline and follow‐up appointments. Results: Five patients were identified and included. Patient diagnoses consisted of refractory joint pain of the hip, knee, or ankle. Mean NRS pain scores improved by 74% from 9.2 at baseline to 2.4 at the last follow‐up (mean = 28 months post‐implant). From baseline to the last follow‐up, mean ODI scores improved by 65% from 66 to 23 and EQ‐5D scores more than doubled from an average of 0.371 to 0.797. Conclusion: This clinical report illustrates the potential utility DRG‐S has in treating pain that clinically presents as predominantly refractory mechanical joint pain without a significant neuropathic component. The physiological reasons for our observations may be that DRG‐S is able to directly influence the conduction of nociceptive signaling at the DRG and within the spinal cord. Further investigations are warranted to determine if DRG‐S is a potential treatment option for chronic mechanical pain. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Pain Practice is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/papr.13180
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 8
        StartPage: 317
    Subjects:
      – SubjectFull: Postoperative pain treatment
        Type: general
      – SubjectFull: Chronic pain treatment
        Type: general
      – SubjectFull: Knee joint
        Type: general
      – SubjectFull: Lumbar pain
        Type: general
      – SubjectFull: Spinal cord
        Type: general
      – SubjectFull: Knee osteoarthritis
        Type: general
      – SubjectFull: Pain measurement
        Type: general
      – SubjectFull: Hip osteoarthritis
        Type: general
      – SubjectFull: Total hip replacement
        Type: general
      – SubjectFull: Total knee replacement
        Type: general
      – SubjectFull: Ankle joint
        Type: general
      – SubjectFull: Hip joint
        Type: general
      – SubjectFull: Arthroscopy
        Type: general
      – SubjectFull: Sensory ganglia
        Type: general
      – SubjectFull: Retrospective studies
        Type: general
      – SubjectFull: Acquisition of data
        Type: general
      – SubjectFull: Severity of illness index
        Type: general
      – SubjectFull: Treatment failure
        Type: general
      – SubjectFull: Causalgia
        Type: general
      – SubjectFull: Electric stimulation
        Type: general
      – SubjectFull: Case studies
        Type: general
      – SubjectFull: Questionnaires
        Type: general
      – SubjectFull: Disabilities
        Type: general
      – SubjectFull: Medical records
        Type: general
      – SubjectFull: Complex regional pain syndromes
        Type: general
      – SubjectFull: Pain management
        Type: general
      – SubjectFull: Nociceptive pain
        Type: general
      – SubjectFull: Neural stimulation
        Type: general
      – SubjectFull: Total ankle replacement
        Type: general
      – SubjectFull: Failed back surgery syndrome
        Type: general
      – SubjectFull: Innervation
        Type: general
    Titles:
      – TitleFull: Dorsal root ganglion stimulation for the treatment of joint pain with predominantly nociceptive characteristics: A case series.
        Type: main
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            NameFull: Chapman, Kenneth B.
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              M: 03
              Text: Mar2023
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