1. 2018;21;E377-E387Dorsal Root Ganglion Stimulation (DRGS) for the Treatment of Chronic Neuropathic Pain: A Single-Center Study with Long-Term Prospective Results in 62 Cases
   Prospective Study
   Bankim S. Chander, MS, Guilherme Lepski, MD, Marcos Fortunato, MD, and Matthias H. Morgalla, MD.

BACKGROUND: Dorsal root ganglion stimulation (DRGS) treats discrete, localized areas of neuropathic pain. But there are no long-term results available so far.

OBJECTIVES: We studied the long-term outcome of DRGS used in the treatment of chronic neuropathic pain.

STUDY DESIGN: A prospective, longitudinal single center investigation.

SETTING: Academic medical center in Germany.

METHODS: Patients (age >18 years) with chronic neuropathic pain in the hands, back, legs, knees and feet were prospectively examined. After a successful test-trial (duration of 3-14 days, pain decrease > 50%), a permanent generator was implanted. The patients were re-examined after 1 year, 2 years and 3 years. We used the Visual Analogue Scale (VAS), the Pain Disability Index (PDI), the Pain Catastrophizing Scale (PCS), the Brief Pain Inventory (BPI), and, the Beck Depression Inventory (BDI) for our assessments.

RESULTS: We included 62 consecutive patients (27 females, 35 males, mean age 56.8 years, with an age range from 28 to 82 years, 62/51 to permanent conversion) during the time period from March 2012 until March 2016. Fifty-one patients had a successful test-trial and a generator was implanted subsequently. Results after 3 years: the VAS dropped from Mdn = 8 to Mdn = 4 (P = 0.0001). The PDI decreased from Mdn = 45 to Mdn = 23 (P = 0.003). The PCS decreased from Mdn = 34 to Mdn = 21 (P = 0.001). The BPI dropped from Mdn = 73 to Mdn = 30 (P = 0.003). The BDI decreased from Mdn = 36 to Mdn = 21 (P = 0.010). Fourteen patients showed complications (27.4%).

LIMITATIONS: This study is limited by the small number of patients in the single groups of the different pain locations.

CONCLUSION: DRGS may be an effective long-term method of treating discrete, localized areas of chronic neuropathic pain. We would recommend DRGS for the treatment of chronic neuropathic pain in such areas.

KEY WORDS: Knee pain, foot pain, hand pain, groin pain, neuromodulation, dorsal root ganglion stimulation, chronic neuropathic pain, paresthesia mapping