Dorsal root ganglion (DRG) stimulation for CRPS and focal nerve pain

Overview

The dorsal root ganglia are small clusters of nerve cells next to the spine. Each one relays feeling from a certain part of the body. DRG stimulation places thin wires near the ganglion that serves the painful area. The wires send mild electrical signals that may calm pain signals from that area. Because it can aim at one part of the body, it may help some people with complex regional pain syndrome (CRPS). It may also help nerve pain in one area, such as the groin, knee or foot. As with spinal cord stimulation, you try it first in a short trial.

Watch: how DRG Stimulation works

Video: “What is Dorsal Root Ganglion (DRG) Therapy?” from Abbott | Neuromodulation on YouTube. It loads from youtube-nocookie.com only when you press play. Shown for general education; GSMC did not produce it. Watch on YouTube

What it is

DRG stimulation is a type of neuromodulation, like spinal cord stimulation (SCS). The difference is the target. SCS leads sit over the spinal cord and cover wider areas. DRG leads are guided to a specific ganglion, which can make it easier to cover pain in one small area, such as a foot or the groin.

Studies have shown meaningful relief for many patients at 12 months. Results vary, and some people do not benefit.

Who it's for

DRG stimulation may help some people with:

• Complex regional pain syndrome (CRPS) types I and II, especially in the legs or feet
• Focal nerve pain in the groin, for example after hernia surgery
• Ongoing knee pain, including after knee replacement
• Nerve pain in the foot or ankle
• Pain in one area that has not improved with other treatments

What the procedure involves, step by step

Step 1: Evaluation. We review your history, exam and imaging. Many insurance plans also ask for a psychological evaluation before a trial.

Step 2: The trial. 1. In an outpatient procedure, the skin is numbed, and light sedation may be used. 2. Using live X-ray guidance, thin temporary leads are placed through a needle into the epidural space and guided to the target ganglion. 3. The leads connect to a small device worn outside the body. 4. For several days, often about a week, you go about your normal routine and track your pain and activity. 5. The temporary leads are removed in the office.

Step 3: The decision. You and your physician review how much your pain and function changed. If the trial did not help enough, nothing more is placed.

Step 4: The permanent implant. 1. If the trial helped, a permanent system is placed in a separate outpatient procedure with sedation or anesthesia. 2. Leads are placed near the target ganglion and connected to a small generator under the skin. 3. Most people go home the same day. Your care team programs the system and shows you how to use it.

Recovery and what to expect

• After the trial, avoid bending, twisting and lifting so the leads do not move.
• After the permanent implant, soreness at the incisions is common for a week or two. You will usually limit bending, twisting and heavy lifting for several weeks while the leads settle.
• Follow-up visits are used to adjust the settings.
• The generator battery may need replacement after some years, depending on the system and use.

Candidacy: who may or may not be a good fit

May be a good fit: people with CRPS or nerve pain in a specific area that has not improved with other care, who have realistic goals and a good response during the trial.

May not be a good fit: people with an active infection, a bleeding problem or blood thinners that cannot be safely paused, untreated mental health conditions that need care first, prior surgery or scarring that blocks access to the target area, or widespread pain better suited to other options. Some people do not get enough relief during the trial.

Risks in brief

Risks include infection, bleeding, lead movement, nerve irritation, pain at the generator site, device problems and the need for another procedure. A spinal fluid leak and headache are uncommon. Nerve injury is rare. Ask about MRI rules for your system before any scan.

Alternatives

Other options may include physical therapy, medicines, sympathetic nerve blocks (for CRPS), peripheral nerve stimulation, traditional spinal cord stimulation or an implanted pain pump.

Frequently asked questions

Insurance

GSMC participates with all Aetna plans, including Aetna HMO, and with many other insurance plans. Coverage for a specific procedure depends on your plan and may need prior authorization; call 732-202-3000 to verify. Our team can help check your benefits before treatment.

See accepted insurance

Related pages

Related conditions

• Neuropathic (nerve) pain
• Foot pain
• Failed Back & Neck Surgery
• Knee Pain

Related treatments and resources

• Spinal cord stimulation
• Sympathetic nerve blocks
• Peripheral nerve stimulation (overview)
• Closed-loop SCS (Evoke)
• High-frequency neurostimulation