DRG Therapy for CRPS


September 28, 2020

What Is DRG Therapy?

Dorsal Root Ganglion Therapy, DRG for short, is a neuromodulatory therapy used to treat chronic pain. Dorsal root ganglions are collections of nerve cells that reside on both sides of each vertebrae at the dorsal root of the spinal nerve. There are approximately 1500 neurons at each dorsal root ganglion that serve as the gateway to pain between various nerves in the body including the brain and spinal cord. DRG therapy works to directly communicate with these sensory neurons and interfere with the pain messages they are sending to the brain. This interference inhibits the pain signals from being sent, therefore, inhibiting the pain. 

DRG therapy uses an implantable power generator, similar to spinal cord stimulation or a miniature pacemaker battery, and up to four electrical leads that are fed through the epidural space. These leads are fed using the same fluoroscopic guidance method as spinal cord stimulation therapy. Once fed to the proper location, the leads are placed in an S shape known as the S shape relief loop typically targeting the sacral and lumbar dorsal root ganglia. The three ligaments surrounding the dorsal root ganglia posteriorly, inferiorly, and superiorly, allow for the stabilization of the leads. Patients are provided with a handheld controller giving them the opportunity to switch between different stimulation settings to control their own pain. The difference between this therapy and spinal cord stimulation therapy is the precision that dorsal root ganglion therapy offers. Spinal cord stimulation provides a broad spectrum coverage for radicular pain while DRG therapy is able to provide a more precise delivery of analgesia. It allows for pain relief to be delivered to the lower back, the groin, even one single toe. 

Dorsal Root Ganglion Therapy and CRPS 

CRPS, or Chronic Regional Pain Syndrome can be a very taxing pain condition. Nerve cells become hypersensitized and things like a draft of air or a simple touch can cause an abnormal pain response. With CRPS, pain loses its protective function to alert us when something is physically wrong and becomes a disease itself. Dorsal root ganglion therapy works to decrease the hyper sensitivity within the nerve cells that comes along with CRPS. This process normalizes the patient’s pain sensations. This type of therapy has proven to be very successful for patients with CRPS. One study compared DRG therapy to spinal cord stimulation therapy in patients with CRPS.  70%-80% of the patients had 80% pain relief with DRG therapy, while 52% had the same level of relief with spinal cord stimulation. Almost 93% of the patients who received DRG therapy reported at least 50% pain relief. 

DRG therapy has proven to be successful but is still an invasive procedure due to the electrical leads being implanted. It is recommended to try noninvasive or less invasive methods first, such as medications, physical therapy, or nerve blocks, before electing to undergo DRG therapy. However, if there is no relief obtained from these less invasive methods, DRG therapy may be the solution to pain relief for patients with CRPS.