Health Problem: Complex regional pain syndrome (CRPS) is characterized by ongoing evoked or spontaneous regional pain that is out of proportion to known trauma or other causative lesion and shows variable progression over time. Type I CRPS (formerly known as reflex sympathetic dystrophy [RSD]) typically occurs after an illness or injury that did not directly damage the affected area. Type II CRPS (formerly known as causalgia) typically follows a nerve injury.
Technology Description: The DRG is considered to have a gatekeeper role in pain and has been the topic of investigation as an alternate anatomic target for neuromodulation as a more targeted variant of neuromodulation therapy. In DRG stimulation, small leads are placed in the intervertebral foramen via percutaneous needle entry into the epidural space under fluoroscopic guidance directly over the targeted DRGs in the lumbar and sacral regions of the spine. A trial may be completed with immediate patient feedback from an awake patient or an extended ambulatory period may be provided. Following a successful trial of neurostimulation with an external generator, a permanent pulse generator is implanted.
Controversy: Spinal cord stimulation (SCS) has been reported to be ineffective in 47% of CRPS patients. Consequently, DRG stimulation is being investigated as an alternate neural target. The safety and effectiveness of DRG stimulation for the relief of CRPS compared with traditional and newer SCS systems is unknown.
Key Questions:
- Is dorsal root ganglion (DRG) stimulation effective in treating chronic complex regional pain syndrome (CRPS) in adults?
- How does DRG stimulation compare with spinal cord stimulation (SCS) or conservative management of CRPS?
- Is DRG stimulation safe for the treatment of CRPS?
- Have definitive patient selection criteria been identified for the use of DRG stimulation in CRPS patients?
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