DRG stimulation is a pain management treatment option that provides pain relief for neuropathic conditions, such as complex regional pain syndrome, pelvic pain, groin neuralgia, extremity pain, and other nerve pain in isolated parts of the body that failed to respond to former conservative treatment options. DRG stimulation treats chronic pain in areas previously difficult to treat with traditional spinal cord stimulation. During the implantation of a DRG stimulator, healthcare professionals implant the device on the dorsal root ganglion. The spinal cord has many dorsal root ganglions, which means physicians can place the stimulator on any of these to better target specific painful regions. 

The dorsal root ganglion contains a pulse generator, leads, and an external remote controller. Healthcare professionals will insert the pulse generator under the skin near the buttocks or abdomen and attach the leads to the pulse generator and tissues near the target treatment area. The pulse generator is the stimulator’s internal battery pack that sends signals to the leads, providing low-grade electrical stimulation to block pain signals from leaving the dorsal root ganglions. Patients using these devices report feeling a tingling sensation in painful areas instead of direct pain signals. Patients can control the intensity of the electrical stimulation with their external remote control. 

Neurostimulation therapy is less invasive than traditional back surgery and is often a last resort treatment option before back surgery. 

Conditions treated

• Complex regional pain syndrome
• Pelvic pain
• Groin neuralgia
• Extremity pain
• Post-amputation pain
• Failed back surgery syndrome 
• Other nerve pain in isolated parts of the body

Benefits

• Provides pain relief by replacing pain signals with soothing, tingling sensation or blocks them completely 
• Outpatient procedure requiring little recovery time
• Reversible procedure
• Trial period allows patient to see if neurostimulation relieves their pain
• Increases ability to sit, walk, and stand for prolonged periods
• Decreases need for pain medication

Procedure

Before your procedure, your doctor may ask you to stop taking non-steroidal anti-inflammatory drugs (NSAIDs), immunosuppressant medication, and blood thinners to reduce your risk of serious complications or infections. If you are pregnant or suspect you are pregnant, talk to your doctor about alternative treatment options. Your healthcare professional may ask you not to eat or drink several hours before the procedure. This procedure cannot be performed if the patient has an active infection or symptoms of a cold, flu, or similar malady. If you experience these symptoms on the day of the procedure, you will need to reschedule your implantation. 

Before the permanent implantation, patients must undergo a trial implant to ensure dorsal root ganglion stimulation is the more effective treatment for their pain relief needs. The trial implantation lasts for five to seven days. Once the trial finishes, patients will discuss the successes and failures of the device with their physician to determine if they should continue with the treatment option. 

During the trial and permanent implant, you will lie on your stomach on a table. The healthcare professional performing your implantation will administer anesthesia, but you will remain conscious during the procedure. Your physician will ask you questions throughout the implantation to ensure the stimulator stimulates the correct area of the body and that you can feel the electrical pulses. 

Your healthcare professional will then make two small incisions near the epidural space to insert the leads. Your physician will connect the leads to the generator, with the generator remaining outside the body, to ensure both devices function correctly. During the trial implantation, they will experiment with positions to place the leads in locations where they will be most effective. During the permanent implantation, they will replace the temporary leads with the permanent leads. Once your physician properly places the leads, they will insert the lead generator in the upper buttock or lower abdomen region. 

The procedure can last anywhere from thirty minutes to two hours.

Once the implantation of both devices ends, you will remain in an observation room to ensure no immediate complications or reactions occur. Once in the observation room, you will learn how to control the device, increase or decrease the electrical stimulation as needed, and use various programs to eliminate pain. Many dorsal root ganglion stimulators offer several set programs to eliminate pain, as well as a constant electrical pulse. Once you know how to function your stimulator, your physician will allow you to leave.

Recovery

You may not drive for the remainder of the day, so you will need someone to drive you home from your implantation. You may experience an increase in pain at the incision location, but this pain will dissipate within a week. If the pain becomes too intolerable, you may take over-the-counter pain relievers. Your physician will direct you when you may use ice therapy to reduce any pain, swelling, or discomfort in the area. 

Keep the incision site clean and dry, and you may only take a sponge bath for the first two weeks after the implantation. You cannot bend, twist, or perform any rigorous activity for at least two weeks. You cannot lift more than five pounds. Your physician will recommend resting as much as possible for the first two weeks following your implantation. They will also provide you with more specific instructions on when you may return to your routine activities and work. 

After two weeks, you will attend your first follow-up appointment to ensure the incision is healing without redness or infection. Your doctor will assess your current pain levels and the effectiveness of the dorsal root ganglion stimulator. They will provide you with additional information on when you can start showering or soaking in water and returning to work. You will have a second follow-up appointment to determine your progress. At this second appointment, your doctor may clear you for all activities but will provide you with more specific instructions at that time.

If, at any point following the implantation, your pain does not improve, call your physician. You will likely meet with a representative from the company that created your stimulator to troubleshoot the device. If reprogramming the device fails to improve the pain, your doctor will discuss removing the implant with you.

If you notice any of the following symptoms, seek immediate medical attention:

• Extreme pain in your legs
• Loss of bowel or bladder control
• Decreased mobility or paralysis in your legs
• Sudden leg numbness
• Fever at 100 degrees F or 37 degrees C

Of those who felt pain relief after a year of using a DRG stimulator, over two-thirds reported feeling pain relief after three months of their implantation. Some patients experience immediate pain relief, while others feel pain relief after several days or weeks. Some patients may take up to several months to feel a significant reduction of their pain levels.

Risk

While the implantation of a dorsal root ganglion stimulator is a generally safe procedure, there remains the risk of complications, including:

• Bleeding, infection, or bruising at incision site
• Allergic reaction to anesthesia
• Stimulation of wrong area
• Stimulator device failure or irregular functionality