Focus of Report: The focus of this health technology assessment is to evaluate the safety and effectiveness of dorsal root ganglion (DRG) stimulation for the treatment of complex regional pain syndrome (CRPS) in adults.

Technology Description: The DRG is considered to have a gatekeeper role in pain and has been the topic of investigation as an anatomical target of neuromodulation therapy for CRPS. In DRG stimulation, small leads are placed in the intervertebral foramen via percutaneous needle. Under fluoroscopic guidance, the needle is inserted into the epidural space directly over the targeted DRGs in the lumbar and sacral regions of the spine. A trial may be completed with immediate patient feedback regarding changes in pain 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) is a generally accepted treatment for patients with CRPS who do not respond to more conservative treatment; however, it may not be effective for all patients with CRPS. 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 not yet established.

Key Questions:

  • Is DRG stimulation effective in treating chronic CRPS in adults?

  • How does DRG stimulation compare with other treatments for CRPS?

  • Is DRG stimulation safe?

  • Have definitive patient selection criteria been identified for DRG stimulation in patients with CRPS?

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