Reno Pain

Dorsal Root Ganglion (DRG) Stimulation

Best Dorsal Root Ganglion (DRG) Stimulation Doctors in Reno, Sparks and Carson City, Nevada.

Dorsal Root Ganglion (DRG) Stimulation

Living with chronic pain is hard enough. Finding a solution shouldn’t be. However, many patients who experience chronic pain in their extremities have also had to deal with treatments that haven’t provided needed solutions. Not only could this be from not receiving an accurate diagnosis, or from not undergoing the best treatment option, but could also be due to the fact that the entire issue is not being treated comprehensively and cohesively. The Nevada Advanced Pain Specialists in the Reno, Sparks and Carson City areas are well equipped to provide an advanced procedure to finally provide relief from complex limb pain with dorsal root ganglion stimulation. 

What is Dorsal Root Ganglion Stimulation?

Dorsal root ganglion (DRG) stimulation is a pain management option for patients who are suffering from difficult-to-treat chronic pain specifically in the lower extremities, which include the foot, knee, hip and groin. It is very similar to spinal cord stimulation but DRG is able to target specific areas of the body. The reason why is because dorsal root ganglion stimulation specifically targets the nerves responsible for certain pain in a particular area of the body. 

The dorsal root ganglia (DRG) are nerve structures located within the spine and contain primary sensory neurons, which are neurons responsible for, among others, pain signaling. The DRG regulates what gets sent to the brain. The body has many dorsal root ganglia, which are responsible for sensation in a different area of the body. By pinpointing the specific nerves that provide pain sensation in the foot or hand, for example, a patient can experience much more profound relief when compared to a general, systemic approach. 

Dorsal root ganglion stimulation works by implanting a small device under the skin close to the targeted dorsal root ganglion. The device sends a mild electrical current that prevents the nerve from sending pain sensations to the brain. So now the patient feels a tingling or buzzing feeling instead of pain. 

DRG Stimulation versus Spinal Cord Stimulation

Dorsal root ganglion stimulation and spinal cord stimulation are basically the same since they both are implanted devices that provide an electrical current to disrupt pain signals, right? Not the case! While similar, there are some significant differences. These include: 

  • The spinal cord stimulation device is implanted in the epidural space of the spine and cannot target a specific area of the body. Instead, it focuses on the entire length of the sciatic nerve, for example. 
  • SCS leads can sometimes shift or move, which can leads to a disruption in pain relief
  • DRG stimulation can target specific areas of the nerves so that pain relief is localized just where it should be
  • The DRG device will not shift with a person’s movement, meaning that pain relief is continuous

Overall, while spinal cord stimulation is a great tool for treating widespread pain, dorsal root ganglion stimulation is a better way to focus on the specific are of the body that is in pain. 

What Conditions Does Dorsal Root Ganglion Stimulation Treat? 

Dorsal root ganglion stimulation has proven extremely effective for treating complex pain conditions, especially when previous treatments have failed to provide the patient with noticeable and sustained pain relief. The three main conditions include: 

  • Complex regional pain syndrome (CRPS)
  • Post-amputation pain (phantom and stump pain)
  • Failed back surgery syndrome

DRG stimulation has also been helpful for patients who suffer from lower abdominal and visceral pain, groin and testicular pain, and chronic, refractory and post-surgical pain. 

Complex Regional Pain Syndrome

CRPS is both difficult to diagnose and challenging to treat. In addition to feelings of intense pain that far outweigh the stimuli, patients who suffer from CRPS can also experience swelling, burning pain, sweating, and hyperalgesia (increased sensitivity to stimuli). To make matters worse, symptoms can even spread to other areas of the body. Traditional treatments have included injections and nerve blocks, but dorsal root ganglion stimulation has been able to provide patients with both short- and long-term pain relief. 

Post-Amputation Pain

Losing a limb via amputation is reported as one of the most painful experiences a person can go through. On top of losing the limb and adjusting to a new way of life, the majority of amputee patients suffer from causalgia, which is a type of limb pain that remains after amputation. Due to the fact that dorsal root ganglion stimulation targets specific pain signaling in the extremities, it has shown effective for relieving pain sensations for the majority of post-amputee patients. 

Failed Back Surgery Syndrome

Failed back surgery syndrome, also known as post-laminectomy syndrome, is an incredibly frustrating situation for a patient. Usually back surgery is a last resort, after all other treatment options have failed to provide relief, so when surgery still didn’t provide pain relief, the patient could lose hope. However, dorsal root ganglion stimulation has been able to provide extended pain relief for the majority of patients who suffer from failed back surgery syndrome, finally providing them with relief. 

How Does the Dorsal Root Ganglion Stimulation Procedure Work?

The dorsal root ganglion stimulation procedure is a minimally-invasive out-patient procedure, meaning that the patient is able to return home the same day. It is also performed in two stages: a trial period and the placement of the permanent device. Both stages are performed under light anesthesia. 

During the initial phase, the provider will implant the trial stimulator leads into the epidural space directly on the targeted dorsal root ganglion (not the spinal cord) where the nerves exit the spinal canal. Once the leads are in place, the provider will send a mild electrical current, which the patient will feel as a tingling or buzzing sensation. The patient will be shown how to control the leads using an external device, so can increase or decrease the stimulation as needed. The trial period usually lasts for about a week, where the patient is encouraged to enjoy as much of their daily lifestyle as possible, but avoiding strenuous activity that could disrupt the leads. 

If the trial period was deemed a success, i.e. the patient experienced significant pain reduction, then a permanent device is implanted. The procedure is the same, but now the leads are placed in a more permanent way and the device battery is implanted in the buttock or abdomen. The stimulation device is still controlled by the patient with an external controller. 

Each implant phase should take less than an hour. Patients can expect their surgical wounds to heal within a couple of months, and can experience significant pain relief around month three, with persistent pain relief thereafter. 

For patients who are suffering from chronic pain, especially chronic limb pain, and who have yet to find a treatment that works, please know there is hope. The Advanced Pain Specialists in the Reno, Sparks and Carson City areas are committed to offering their patients the most revolutionary, safe, and state-of-the-art treatment methods with the goal to provide the most minimally-invasive treatment options that yield the greatest results. If you would like more information about dorsal root ganglion stimulation or would like to know if you’re a candidate, please schedule an appointment today.

DRG Stimulation is similar to typical Spinal Cord Stimulation but stimulates the DRG for more selective targeting of pain areas that are hard to reach. The DRG stimulator is implanted in a similar fashion to the typical spinal cord stimulator (SCS). However, unlike the traditional method, the leads (or small coated wires) stimulate the DRG and not the spinal cord. The DRG is a spinal structure packed with sensory nerves that transmit information to the spinal cord, which then conducts those signals to the brain.

DRG stimulation offers selective targeting of areas currently not as easily treated by traditional spinal cord stimulation, including the groin, lower leg and feet. This kind of stimulation is better for smaller, more specific areas of pain, as it can target a more specific area than traditional SCS, which is better for larger areas of pain. It is particularly effective in relieving chronic lower limb pain associated with complex regional pain syndrome (CRPS) and peripheral causalgia (nerve damage).

DRG stimulation also offers fewer side effects than traditional spinal cord stimulation. In a study done by St. Jude Medical, participants reported no difference in the intensity of paresthesia’s due to postural changes, which is a common side effect of traditional SCS therapy. This means that with traditional SCS therapy, sometimes a change in the patient’s posture can cause a difference in intensity or an abnormal sensation such as tingling or pricking. DRG provides a more focused stimulation that is typically confined to the painful area while helping to avoid unwanted stimulation.

Trial

The implantation process for the DRG stimulator is very similar to the implantation of a typical SCS. Like the typical SCS, the implantation of a DRG stimulator begins with a trial. A trial typically lasts 5 – 7 days. Typically, this procedure will be done at an ambulatory surgery center or hospital under light sedation. The trial stimulator leads are temporarily implanted percutaneously through an epidural needle into the epidural space (the area surrounding the spinal cord). Once the leads are in the epidural space, your physician will then position the leads to stimulate the DRG, instead of the spinal cord. The DRG is located in the lateral recesses of the epidural space. Your physician will know which DRG targets to stimulate based off of your pain complaints. Once the leads are properly placed, they are then connected to a trial stimulator battery that is external.

During the trial, patients are able to control their device to alleviate their pain. They can turn the device on and off as needed, they can turn the stimulation up or down for comfort, and there are multiple different programs they can use to help eliminate their pain. At the conclusion of the trial, the temporary leads will be removed and the patient and physician will determine if a permanent device is the right fit.

Permanent Implantation

If you and your physician determine that the trial was successful, a permanent stimulator may be implanted. For the permanent implantation, the procedure will be done at an ambulatory surgery center or hospital under conscious sedation directed by an anesthesiologist. Two small incisions are made to complete the procedure. Permanent leads are implanted through the predetermined location in the epidural space. Next, the leads are connected to a battery. Once the leads are connected to the battery, it is implanted in the upper buttock or abdomen region. The procedure takes around 40 minutes to complete.

When the procedure is finished, the implant’s electrical pulses are programmed with an external control unit that the patient is able to use to control the system. Patients are trained in how to use the control unit before leaving. Once again they can use the control unit to turn the system on and off, adjust the stimulation level and switch between programs to alleviate their pain. The patient is able to go home after the procedure and the programming is done.

The DRG stimulator is a very exciting new advancement that is offered at Nevada Advanced Pain Specialists.

Check out this video of Dr. Patterson on Channel 2 News!
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Nevada Advanced Pain Specialists is recognized as an industry leader in pain management. We have a state-of-the-art facility in Reno, Nevada, that allows for us to offer the highest possible level of quality care of our patients.

We are committed to providing a comprehensive and multi-disciplinary approach for each individual’s pain complaints to provide the most appropriate care. Our approach includes analysis of biomechanics, joint motion, as well as skeletal, nerve and muscle tissues. Every individual is evaluated for the root cause of their pain – not just a “quick fix” approach to only provide symptomatic relief.

Your pain will be evaluated with latest diagnostic tools and technologies used by the professionals at Nevada Advanced Pain Specialists to make accurate assessments including: EMG/Nerve testing, MRIs, x-rays, bone scans, and diagnostic pain injections.

Your comprehensive treatment plan will help you eliminate chronic pain and get you back into a healthy life.

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