A Systematic Literature Review of Dorsal Root Ganglion Neurostimulation for the Treatment of Pain

Abstract

Objective To conduct a systematic literature review of dorsal root ganglion (DRG) stimulation for pain. Design Grade the evidence for DRG stimulation. Methods An international, interdisciplinary work group conducted a literature search for DRG stimulation. Abstracts were reviewed to select studies for grading. General inclusion criteria were prospective trials (randomized controlled trials and observational studies) that were not part of a larger or previously reported group. Excluded studies were retrospective, too small, or existed only as abstracts. Studies were graded using the modified Interventional Pain Management Techniques–Quality Appraisal of Reliability and Risk of Bias Assessment, the Cochrane Collaborations Risk of Bias assessment, and the US Preventative Services Task Force level-of-evidence criteria. Results DRG stimulation has Level II evidence (moderate) based upon one high-quality pivotal randomized controlled trial and two lower-quality studies. Conclusions Moderate-level evidence supports DRG stimulation for treating chronic focal neuropathic pain and complex regional pain syndrome.

Auricular Vagus Neuromodulation—A Systematic Review on Quality of Evidence and Clinical Effects

“…They concluded that thorough consideration of control design and consequent subject and investigator blinding is essential to improve the quality of evidence on SCS therapy for pain (Duarte et al, 2020a). A systematic review of dorsal root ganglion (DRG) stimulation for pain also showed serious concern for bias across all studies reviewed due to compromised subject and investigator blinding (Deer et al, 2020). The suggestions laid forth on measuring local target engagement and consistent post-hoc evaluation of blinding in subjects and investigators will expand our knowledge of effective control design for paresthesia inducing neuromodulation therapies such as aVNS, SCS, and implantable VNS.…”

“…We performed a systematic review of aVNS RCTs with two primary goals: (1) to provide an accessible framework for the aVNS community to review current studies for specific outcome measures as a resource to inform future study design and (2) to perform a qualitative assessment of the current level of clinical evidence to support aVNS efficacy for the most common outcome measures reported. To this end, the Cochrane Risk of Bias Tool (Sterne et al, 2019)-a framework previously used to identify risk of bias in RCT studies of epidural spinal cord stimulation (Duarte et al, 2020b) and dorsal root ganglion stimulation (Deer et al, 2020) to treat pain-was first used to assess the quality of evidence in individual aVNS RCTs. These data were aggregated to broadly assess the current level of clinical evidence, according to the Oxford CEBM scale, to support aVNS efficacy across the common physiological outcomes.…”

Effect of Patient Characteristics on Clinical Outcomes More Than 12 Months Following Dorsal Root Ganglion Stimulation Implantation: A Retrospective Review

“…DRG stimulation has proven to be effective in those conditions where it is difficult to get appropriate coverage with a dorsal column spinal cord stimulation (SCS) system (8). The initial idea to target the DRG for pain control was developed in 1949, but stimulation of the DRG for the treatment of chronic pain was not described until 1991 (9,10).…”

Comparison of Spinal Cord Stimulation vs. Dorsal Root Ganglion Stimulation vs. Association of Both in Patients with Refractory Chronic Back and/or Lower Limb Neuropathic Pain: An International, Prospective, Randomized, Double-Blinded, Crossover Trial (BOOST-DRG Study)

“…One major target appears to be located at the dorsal root ganglion (DRG) level and plays a crucial role in pain generation [20,21]. To validate this hypothesis, medical device and neuromodulation industries have developed DRG stimulation (DRGS) [22]. DRGS appears to be a promising technology for patients suffering from refractory chronic neuropathic pain, and particularly focal pain, since it operates more selectively on the nervous system [22][23][24][25][26][27][28].…”