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Dorsal Root Ganglion Stimulation

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New and emerging neurostimulation devices are becoming a preferred non-opioid alternative for treating chronic pain.  Spinal cord stimulation (SMS) is one of these options, however for some patients, it isn’t sufficiently effective for complex regional pain syndrome in the lower extremities – areas such as the hand, chest, abdomen, foot, knee or groin. Since early 2016, the FDA has approved an additional alternative – dorsal root ganglion (DRG) stimulation.

The concept behind dorsal root ganglion (DRG) stimulation is nearly identical to traditional spinal cord stimulation (SMS).  With both options, a small device, similar to a pacemaker, is implanted in the body and pain signals are masked before the reach the brain.  However, there is a key difference.  With spinal cord stimulation, leads are placed in the general region of the spinal cord, while dorsal root ganglion therapy targets posterior nerve roots in a way that permits focused therapy to specific defined areas of the body.

Before a dorsal root ganglion stimulator is permanently implanted, a trial stimulation is always performed. If the trial does not live up to expectations, the trial wires can be removed in a simple office procedure with almost no discomfort and without damaging the spinal cord and nerves.

St. Jude Medical™ Axium™ Neurostimulator

St. Jude Medical™ Axium™ Neurostimulator
Treatment in Depth
Dorsal root ganglion (DRG) stimulation can help manage chronic hand, chest, abdomen, foot, knee or groin pain even when other therapies have failed. With dorsal root ganglion, a small pulse generator and thin wires (known as leads) are implanted in the back. DRG is controlled by a hand-held remote that turns the device on and off and adjusts the settings. The pulse generator is similar in function and appearance to cardiac pacemakers, except that the electrical pulses are sent to the dorsal root ganglion instead of to the heart.

These “pacemakers for pain” interrupt the pain signals’ pathways to the brain by delivering low-intensity electrical pulses that trigger selective nerve fibers on the dorsal root ganglion, a cluster of neurons in the posterior root of spinal nerves. DRG stimulation offers a highly-directed stimulation field, which can limit stimulation to a specific pain area.

Because the layer between the lead wires and the dorsal root ganglion cells is so narrow, dorsal root ganglion (DRG) stimulation uses only about 10 percent of the energy required for traditional spinal cord stimulation (SMS). That, in turn, leads to longer-lasting batteries.  In addition, the pattern of stimulation for DRG is constant, where that pattern of SMS stimulation can vary according to body position – as a result, DRG pain relief is much more consistent by comparison.

Manufacturers and Dorsal Root Ganglion Stimulator Options
The dorsal root ganglion (DRG) stimulation market is far newer than the spinal cord stimulation market segment.  St. Jude Medical (a division of Abbott Laboratories) is currently the first manufacturer of a neurostimulation device designed for dorsal root ganglion (DRG) therapy.  They have built on their long experience with spinal cord stimulators.

St. Jude Medical’s Axium™ Neurostimulator System is approved by the FDA to treat patients with neuropathic chronic intractable pain associated with complex regional pain syndrome of the lower limbs.

Each dorsal root ganglion stimulation pulse generator features programmable settings. These settings can be adjusted to help you receive the best therapy possible. Your doctor will customize your system so that your pulse generator operates optimally for your individual situation.

Trial Period and Implant Procedure
The first step in the dorsal root ganglion (DRG) treatment process typically involves a test stimulation or trial period in which the patient receives an external test stimulator in a simple outpatient procedure. During the three- to ten-day trial period, patients receive stimulation through thin wires (leads) connected to an external trialing cable.

If the trial procedure is successful, a dorsal root ganglion stimulator about the size of a small pocket watch is implanted under the skin in a minimally invasive outpatient procedure. The neurostimulator delivers controlled electrical pulses through leads to the dorsal root ganglion to block pain signals from reaching the brain. Your physician will adjust the stimulation settings to optimize the therapy and pain control for you.

Insurance Coverage
Most insurance companies will pay for the trial and permanent implantation of a dorsal root ganglion stimulator. However, as with many costly treatment options, your physician will have to get precertification from your insurance company before you can receive atrial or permanent implant. Your out-of-pocket (copay and/or deductible) costs will vary according to your insurance plan. Consult your physician or insurance carrier for more detailed information about out of pocket expenses associated with the trial and permanent implantation of a dorsal root ganglion stimulator.

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