Dorsal root ganglion stimulation for the treatment of chronic pelvic pain: A systematic review

Abstract

BackgroundChronic pelvic pain (CPP) is a difficult condition to treat. Due to complex pelvic innervation, dorsal column spinal cord stimulation (SCS) has not been shown to produce the same effect as dorsal root ganglion stimulation (DRGS) given emerging evidence suggesting that applying DRGS may result in favorable outcomes for individuals with CPP. The aim of this systematic review is to investigate the clinical use and effectiveness of DRGS for patients with CPP.Materials and MethodsA systematic review of clinical studies demonstrating the use of DRGS for CPP. Searches were conducted using four electronic databases (PubMed, EMBASE, CINAHL, and Web of Science) across August and September 2022.ResultsA total of nine studies comprising 65 total patients with variable pelvic pain etiologies met the inclusion criteria. The majority of subjects implanted with DRGS reported >50% mean pain reduction at variable times of follow‐up. Secondary outcomes reported throughout studies including quality of life (QOL) and pain medication consumption were reported to be significantly improved.ConclusionsDorsal root ganglion stimulation for CPP continues to lack supportive evidence from well‐designed, high‐quality studies and recommendations from consensus committee experts. However, we present consistent evidence from level IV studies showing success with the use of DRGS for CPP in reducing pain symptoms along with reports of improved QOL through periods as short as 2 months to as long as 3 years. Because the available studies at this time are of low quality with a high risk of bias, we strongly recommend the facilitation of high‐quality studies with larger sample sizes in order to better ascertain the utility of DRGS for this specific patient population. At the same time, from a clinical perspective, it may be reasonable and appropriate to evaluate patients for DRGS candidacy on a case‐by‐case basis, especially those patients who report CPP symptoms that are refractory to noninterventional measures and who may not be ideal candidates for other forms of neuromodulation.

Mechanisms of Action of Dorsal Root Ganglion Stimulation

“…Recent studies have underscored the favorable outcomes of DRG-S neuromodulation compared to SCS across various conditions, including chronic pelvic pain, painful diabetic neuropathy, restless leg syndrome, and post-surgical or traumatic painful scars. These studies have demonstrated notable enhancements in quality of life, increased patient satisfaction, reduced medication dependency, and long-term cost-effectiveness [50][51][52][53]. Failed back surgery syndrome (FBSS) is usually refractory to conservative medical management.…”