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Neuromodulation of the dorsal root ganglion

W Porter McRoberts, Catalina Apostol, Abdul Haleem
UNLABELLED: Complex regional pain syndrome (CRPS) presents a therapeutic challenge due to its many presentations and multifaceted pathophysiology. There is no approved treatment algorithm and clinical interventions are often applied empirically. In cases of CRPS where symptoms are localized to an extremity, a targeted treatment is indicated. We describe the use of intrathecal bupivacaine monotherapy, delivered through a retrograde catheter, in the treatment of CRPS affecting the lower extremity...
September 2016: Pain Physician
Paul Verrills, Chantelle Sinclair, Adele Barnard
Spinal cord stimulation (SCS) applications and technologies are fast advancing. New SCS technologies are being used increasingly in the clinical environment, but often there is a lag period between the clinical application and the publishing of high-quality evidence on safety and efficacy. Recent developments will undoubtedly expand the applicability of SCS, allowing more effective and individualized treatment for patients, and may have the potential to salvage patients who have previously failed neuromodulation...
2016: Journal of Pain Research
Vanessa Milanesi Holanda, Maria Cristina Chavantes, Daniela Fatima Teixeira Silva, Carlos Vanderlei M de Holanda, José Oswaldo de Oliveira, Xingjia Wu, Juanita J Anders
BACKGROUND AND OBJECTIVE: Chronic low back pain is a worldwide public health issue with high socioeconomic impact. The aim of this study was to determine the efficacy of laser irradiation of the dorsal root ganglion of the second lumbar spinal nerve for chronic axial low back pain compared to lidocaine injection and radiofrequency treatment. STUDY DESIGN/MATERIALS AND METHODS: Twenty-eight patients were randomly divided into three treatment groups: lidocaine injection, radiofrequency, or laser...
September 2016: Lasers in Surgery and Medicine
X Zuidema, J Breel, F Wille
Chronic perineal pain limits patients in physical and sexual activities, leading to social and psychological distress. In most cases, this pain develops after surgery in the urogenital area or as a consequence of trauma. Neuromodulation is one of the options in chronic postsurgical perineal pain treatment. We present a case of refractory perineal pain after right sided surgical resection of a Bartholin's cyst which was treated with third sacral nerve root/dorsal root ganglion stimulation using the transforaminal approach...
2016: Case Reports in Neurological Medicine
Feline F J A Ter Bruggen, Ismail Eralp, Leo Leliveld, Chris Jansen, Dirk L Stronks, Frank J P M Huygen
OBJECTIVE: During implantation of a neuromodulative system, high patient satisfaction is closely associated with the equilibrium between an effective analgesia and sedation regimen, and the possibility for the patient to be awake and cooperative during procedure. This study assessed the efficacy of the sedative dexmedetomidine to achieve this balance, with patient satisfaction as the primary outcome. METHODS: Ten patients undergoing implantation of a dorsal column and dorsal root ganglion stimulator received dexmedetomidine (1 mcg/kg over 10 minutes, followed by 0...
February 23, 2016: Pain Practice: the Official Journal of World Institute of Pain
Liong Liem, Nagy Mekhail
Chronic neuropathic groin pain is a sequela of hernia surgery that occurs at unacceptably high rates, causing widespread impacts on quality of life. Although the medical community is beginning to recognize the role of surgical technique in the initiation and maintenance of postherniorrhaphy neuropathic pain, little information exists regarding pain management strategies for this condition. This review presents a summary of the pain condition state, its treatment options, and treatment recommendations. Both literature review and clinical experience were used to develop a proposed a treatment algorithm for the treatment of postherniorrhaphy pain...
September 2016: Pain Practice: the Official Journal of World Institute of Pain
Bruno L Pessoa, Gabriel Escudeiro, Osvaldo J M Nascimento
Neuropathic pain is a series of well-known conditions caused by diseases or lesions to the somatosensory system. Due to the better understanding of the pathophysiology of neuropathic pain, previously unexplored therapies have been used with encouraging results. As such, Acetyl-L-carnitine (ALC), Alpha-lipoic-acid (ALA), cannabinoids, Clonidine, EMA401, Botulinum Toxin type A, and new voltage-gated sodium channel blockers, can be cited. Furthermore, new modalities in neuromodulation such as high-frequency spinal cord stimulation, burst stimulation, dorsal root ganglion stimulation, transcranial direct current stimulation, and many others have been showing exciting results...
December 2015: Current Pain and Headache Reports
Lei Li, Ting Yu, Liling Yu, Haijun Li, Yongjuan Liu, Dongqin Wang
Diabetic peripheral neuropathy (DPN) is a common complication of diabetes lacking of effective treatments. Enhanced excitability of dorsal root ganglion (DRG) neuron plays a crucial role in the progression of diabetic neuropathic hyperalgesia. Brain-derived neurotrophic factor (BDNF) is known as a neuromodulator of nociception, but whether and how BDNF modulates the excitability of DRG neurons in the development of DPN remain to be clarified. This study investigated the role of exogenous BDNF and its high-affinity tropomyosin receptor kinase B (TrkB) in rats with streptozotocin-induced diabetic neuropathic pain...
August 2016: International Journal of Neuroscience
Liong Liem
Dorsal root ganglion (DRG) stimulation has recently emerged as a new neuromodulation modality that stays on the intersection of the peripheral and central nervous system. With DRG location within the spinal column and with electrodes for DRG stimulation placed through the intraspinal epidural space, it may make more sense to group DRG stimulation together with more commonly used spinal cord stimulation (SCS) rather than peripheral nerve stimulation (PNS), particularly if one agrees that the stimulation delivered to DRG partly works downstream at the spinal cord level...
2015: Progress in Neurological Surgery
Sam Eldabe, Katja Burger, Heinrich Moser, Daniel Klase, Stefan Schu, Anders Wahlstedt, Bernard Vanderick, Eric Francois, Jeffery Kramer, Jeyakumar Subbaroyan
OBJECTIVES: Phantom limb pain (PLP) is a neuropathic condition in which pain is perceived as arising from an amputated limb. PLP is distinct from, although associated with, pain in the residual limb and nonpainful phantom sensations of the missing limb. Its treatment is extremely challenging; pharmaceutical options, while commonly employed, may be insufficient or intolerable. Neuromodulatory interventions such as spinal cord stimulation have generated mixed results and may be limited by poor somatotopic specificity...
October 2015: Neuromodulation: Journal of the International Neuromodulation Society
Gang Chen, Chul-Kyu Park, Rou-Gang Xie, Ru-Rong Ji
Neuropathic pain remains a pressing clinical problem. Here, we demonstrate that a local, intrathecal (i.t.) injection of bone marrow stromal cells (BMSCs) following lumbar puncture alleviates early- and late-phase neuropathic pain symptoms, such as allodynia and hyperalgesia, for several weeks in murine chronic constriction injury (CCI) and spared nerve injury models. Moreover, i.t. BMSCs reduced CCI-induced spontaneous pain and axonal injury of dorsal root ganglion (DRG) neurons and inhibited CCI-evoked neuroinflammation in DRGs and spinal cord tissues...
August 3, 2015: Journal of Clinical Investigation
Akshay Garg, Houman Danesh
OBJECTIVE: Targeting the dorsal column, spinal cord stimulation (SCS) serves as a treatment method for complex regional pain syndrome (CRPS). Certain anatomical pain distributions are difficult to treat with traditional SCS, including the distal extremities. We present a case where stimulation of the dorsal root ganglion (DRG) was performed to treat CRPS in the distal upper extremity. CASE REPORT: A 43-year-old female underwent a right elbow arthroscopy with open reduction and internal fixation after sustaining a radial head fracture...
December 2015: Neuromodulation: Journal of the International Neuromodulation Society
Hui Liu, Qing-Feng Wu, Jia-Yin Li, Xing-Jun Liu, Kai-Cheng Li, Yan-Qing Zhong, Dan Wu, Qiong Wang, Yin-Jing Lu, Lan Bao, Xu Zhang
Fibroblast growth factor (FGF) 7, a member of FGF family, is initially found to be secreted from mesenchymal cells to repair epithelial tissues. However, its functions in the nervous system are largely unknown. The present study showed that FGF7 was a neuromodulator localized in the large dense-core vesicles (LDCVs) in nociceptive neurons. FGF7 was mainly expressed in small-diameter neurons of the dorsal root ganglion and could be transported to the dorsal spinal cord. Interestingly, FGF7 was mostly stored in LDCVs that did not contain neuropeptide substance P...
October 2015: Journal of Molecular Cell Biology
Elliot S Krames
BACKGROUND: In the not-too-distant past, the dorsal root ganglion (DRG) was portrayed as a passive neural structure without involvement in the development or maintenance of chronic neuropathic pain (NP). The DRG was thought of as a structure that merely "supported" physiologic communication between the peripheral nervous system (PNS) and the central nervous system (CNS). Newer scientific information regarding the anatomic and physiologic changes that occur within the DRG as a result of environmental pressures has dispelled this concept and suggests that the DRG is an active participant in the development of NP...
January 2015: Neuromodulation: Journal of the International Neuromodulation Society
Jeffery Kramer, Liong Liem, Marc Russo, Iris Smet, Jean-Pierre Van Buyten, Frank Huygen
OBJECTIVES: One prominent side effect from neurostimulation techniques, and in particular spinal cord stimulation (SCS), is the change in intensity of stimulation when moving from an upright (vertical) to a recumbent or supine (horizontal) position and vice versa. It is well understood that the effects of gravity combined with highly conductive cerebrospinal fluid provide the mechanism by which changes in body position can alter the intensity of stimulation-induced paresthesias. While these effects are well established for leads that are placed within the more medial aspects of the spinal canal, little is known about these potential effects in leads placed in the lateral epidural space and in particular within the neural foramina near the dorsal root ganglion (DRG)...
January 2015: Neuromodulation: Journal of the International Neuromodulation Society
Stephanie C Stotz, Lucas Om Scott, Christopher Drummond-Main, Yosef Avchalumov, Fernando Girotto, Jörn Davidsen, Maria R Gómez-Gárcia, Jong M Rho, Evgeny V Pavlov, Michael A Colicos
BACKGROUND: Inorganic polyphosphate (polyP) is a highly charged polyanion capable of interacting with a number of molecular targets. This signaling molecule is released into the extracellular matrix by central astrocytes and by peripheral platelets during inflammation. While the release of polyP is associated with both induction of blood coagulation and astrocyte extracellular signaling, the role of secreted polyP in regulation of neuronal activity remains undefined. Here we test the hypothesis that polyP is an important participant in neuronal signaling...
2014: Molecular Brain
Jason J Song, Adrian Popescu, Russell L Bell
BACKGROUND: Spinal cord stimulation is an intervention that has become increasingly popular due to the growing body of literature showing its effectiveness in treating pain and the reversible nature of the treatment with implant removal. It is currently approved by the FDA for chronic pain of the trunk and limbs, intractable low back pain, leg pain, and pain from failed back surgery syndrome. In Europe, it has additional approval for refractory angina pectoris and peripheral limb ischemia...
May 2014: Pain Physician
Stefan Schu, Ashish Gulve, Sam ElDabe, Ganesan Baranidharan, Katharina Wolf, Walter Demmel, Dirk Rasche, Manohar Sharma, Daniel Klase, Gunnar Jahnichen, Anders Wahlstedt, Harold Nijhuis, Liong Liem
BACKGROUND: Spinal cord stimulation (SCS) is a standard treatment option for chronic neuropathic pain. However, some anatomical pain distributions are known to be difficult to cover with traditional SCS-induced paresthesias and/or may also induce additional, unwanted stimulation. We present the results from a retrospective review of data from patients with groin pain of various etiologies treated using neuromodulation of the dorsal root ganglion (DRG). METHODS: Data from 29 patients with neuropathic groin pain were reviewed...
April 2015: Pain Practice: the Official Journal of World Institute of Pain
Ryo Miyamoto, Ken-Ichi Otsuguro, Soichiro Yamaguchi, Shigeo Ito
Hydrogen sulfide (H2 S) is a gaseous neuromodulator produced from L-cysteine. H2 S is generated by three distinct enzymatic pathways mediated by cystathionine γ-lyase (CSE), cystathionine β-synthase (CBS), and mercaptopyruvate sulfurtransferase (MPST) coupled with cysteine aminotransferase (CAT). This study investigated the relative contributions of these three pathways to H2 S production in PC12 cells (rat pheochromocytoma-derived cells) and the rat dorsal root ganglion. CBS, CAT, and MPST, but not CSE, were expressed in the cells and tissues, and appreciable amounts of H2 S were produced from L-cysteine in the presence of α-ketoglutarate, together with dithiothreitol...
July 2014: Journal of Neurochemistry
Liong Liem, Marc Russo, Frank J P M Huygen, Jean-Pierre Van Buyten, Iris Smet, Paul Verrills, Michael Cousins, Charles Brooker, Robert Levy, Timothy Deer, Jeffery Kramer
OBJECTIVES: This multicenter prospective trial was conducted to evaluate the clinical performance of a new neurostimulation system designed to treat chronic pain through the electrical neuromodulation of the dorsal root ganglia (DRG) neurophysiologically associated with painful regions of the limbs and/or trunk. MATERIALS AND METHODS: Thirty-two subjects were implanted with a novel neuromodulation device. Pain ratings during stimulation were followed up to six months and compared with baseline ratings...
September 2013: Neuromodulation: Journal of the International Neuromodulation Society
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