Metabolic Imaging of Pain Matrix Using 18F Fluoro-deoxyglucose Positron Emission Tomography/Computed Tomography for Patients Undergoing L2 Dorsal Root Ganglion Stimulation for Low Back Pain

Mehta, Vivek; Bouchareb, Yassine; Ramaswamy, Shankar; Ahmad, Alia; Wodehouse, Theresa; Haroon, Athar

doi:10.1111/ner.13095

Cited by 9 publications

(11 citation statements)

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“…DRG stimulation has emerged as a promising therapy for the primary sensory neurons of the DRG, which are target sites for the pathophysiologic changes that lead to neuropathic pain (57). The DRG contains the somata of the primary sensory neuron (PSN).…”

Section: Discussionmentioning

confidence: 99%

Three-Year Outcomes After Dorsal Root Ganglion Stimulation in the Treatment of Neuropathic Pain After Peripheral Nerve Injury of Upper and Lower Extremities

Kretzschmar

Reining

Schwarz

2021

Neuromodulation: Technology at the Neural Interface

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Objectives Traumatic peripheral nerve injuries (PNI) often result in severe neuropathic pain which typically becomes chronic, is recalcitrant to common analgesics, and is associated with sleep disturbances, anxiety, and depression. Pharmacological treatments proven to be effective against neuropathic pain are not well tolerated due to side effects. Neuromodulative interventions such as peripheral nerve or spinal cord stimulation have generated mixed results and may be limited by reduced somatotopic specificity. Dorsal root ganglion (DRG) stimulation may be more effective in this etiology. Materials and Methods Twenty‐seven patients were trialed with a DRG neurostimulation system for PNI; trial success (defined as ≥50% pain relief) was 85%, and 23 patients received a permanent stimulator. However, 36‐month outcome data was only available for 21 patients. Pain, quality of life, mental and physical function, and opioid usage were assessed at baseline and at 3‐, 6‐, 12‐, 18‐, 24‐, and 36 months post‐permanent implant. Implant‐related complications were also documented. Results Compared to baseline, we observed a significant pain relief (p < 0.001) at 3 (58%), 12 (66%), 18 (69%), 24 (71%), and 36 months (73%) in 21 patients (52.5 ± 14.2 years; 12 female), respectively. Mental and physical function showed immediate and sustained improvements. Participants reported improvements in quality of life. Opioid dosage reduced significantly (p < 0.001) at 3 (30%), 12 (93%), 18 (98%), 24 (99%), and 36 months (99%), and 20 of 21 patients were completely opioid‐free after 36 months. There were five lead migrations and two electrode fractures (corrected by surgical intervention) and one wound infection (conservatively managed). Conclusions DRG neuromodulation appears to be a safe, effective, and durable option for treating neuropathic pain caused by PNI. The treatment allows cessation of often ineffective pharmacotherapy (including opioid misuse) and significantly improves quality of life.

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Section: Discussionmentioning

confidence: 99%

Three-Year Outcomes After Dorsal Root Ganglion Stimulation in the Treatment of Neuropathic Pain After Peripheral Nerve Injury of Upper and Lower Extremities

Kretzschmar

Reining

Schwarz

2021

Neuromodulation: Technology at the Neural Interface

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“…DRG stimulation unlike SCS acts directly on the primary sensory neurons of the DRG, which represent an important target in the pathophysiological mechanism of many types of neuropathic pain [54]; the DRG contains the primary sensory neuron (PSN) cell bodies and their T-junctions. It is precisely in the T-junction that the failure of the central projection of sensory information can be jammed, just as in this area modulation occurs for the sensory control of peripheral stimuli, especially painful ones [55 -57].…”

Section: Resultsmentioning

confidence: 99%

Dorsal Root Ganglion Stimulation for the Management of Chronic Neuropathic Pain: A Retrospective Case Series during Four Years follow-up in a Single Center

Papa¹,

Saracco²,

Dato³

et al. 2020

TOPAINJ

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Objectives: The dorsal root ganglion (DRG) is involved in the transduction of pain signals to the central nervous system (CNS) and undergoes a number of physiopathological changes during chronic pain. The purpose of this data collection was to evaluate the long-term safety and efficacy of DRG stimulation for the treatment of chronic pain and its impact on functional aspects. Materials and Methods: Forty-four subjects with non-reactive chronic neuropathic pain syndrome were implanted with DRG stimulation. Patients were evaluated at baseline as well as at 15, and 30 days, and at 3, 6, 12, 24, 36 and 48 months after medical intervention/surgery using the Visual Analogic Scale (VAS), which measures pain intensity, and the Oswestry Scale, for the estimation of disability (ODI). Results: After four years of simulation, VAS and ODI showed a statistically significant reduction throughout the follow-up period. The average pain relief obtained after 48 months of treatment was 74.1% ± 3.4. Conclusion: The results of this data collection demonstrate the feasibility of DRG stimulation, the correspondence between the clinical indications at the DRG implant and what is commonly found in the literature on this technique.(18,20) Patients defined as clinical responders to DRG stimulation and so implanted with definitive IPG showed a sustained and long term efficacy. Eight patients had previously been implanted with a traditional SCS without any clinically relevant efficacy; they were then explained for unsatisfactory results. Six of them (75%) were later implanted with DRG, with long-term effectiveness. Another advantage of this therapy is the absence of positional effects and lead migration. The adverse events proved to be independent of the anatomical level of insertion; moreover, this series of cases show a lower incidence of lead migration than reported in the literature. In summary, DRGs have been ignored for too long, probably due to the technical difficulty of reaching their deep, almost extra-spinal anatomical position.

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“…Eleven articles described a supraspinal hypothesis that was not proposed as a main hypothesis in other articles [20,37,38,[41][42][43]55,56,[62][63][64]. Lind et al targeted the human cerebrospinal fluid (CSF) in 14 SCS responsive neuropathic pain patients and revealed that 68 proteins were significantly altered when using SCS [55].…”

Section: Miscellaneousmentioning

confidence: 99%

Section: Miscellaneousmentioning

confidence: 99%

“…Two studies mentioned the function of SCS on regions of the pain matrix [41,56]. It was hypothesized that DRG stimulation could reverse the dysregulation that is induced by chronic pain in regions of the pain matrix [56]. Buentjen et al suggested that SCS leads to a normalization of pathological spatiotemporal oscillatory patterns generated in the pain network, based on experiments with resting-state electroencephalography (EEG) [41].…”

Section: Miscellaneousmentioning

confidence: 99%

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Exploration of the Supraspinal Hypotheses about Spinal Cord Stimulation and Dorsal Root Ganglion Stimulation: A Systematic Review

Goudman

Groote

Linderoth

et al. 2021

JCM

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Despite the established efficacy and effectiveness of Spinal Cord Stimulation (SCS), there is still no consensus on the supraspinal mechanisms of action of this therapy. The purpose of this study was to systematically review previously raised hypotheses concerning supraspinal mechanisms of action of SCS based on human, animal and computational studies. Searches were conducted using four electronic databases (PubMed, EMBASE, SCOPUS and Web of Science), backward reference searching and consultation with experts. The study protocol was registered prior to initiation of the review process (PROSPERO CRD42020161531). A total of 54 publications were included, 21 of which were animal studies, and 33 were human studies. The supraspinal hypotheses (n = 69) identified from the included studies could be categorized into six groups concerning the proposed supraspinal hypothesis, namely descending pathways (n = 24); ascending medial pathway (n = 13); ascending lateral pathway (n = 10); affective/motivational influences (n = 8); spinal–cerebral (thalamic)-loop (n = 3) and miscellaneous (n = 11). Scientific support is provided for the hypotheses identified. Modulation of the descending nociceptive inhibitory pathways, medial and lateral pathways were the most frequently reported hypotheses about the supraspinal mechanisms of action of SCS. These hypotheses were mainly supported by studies with a high or moderate confidence in the body of evidence.

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Metabolic Imaging of Pain Matrix Using 18F Fluoro-deoxyglucose Positron Emission Tomography/Computed Tomography for Patients Undergoing L2 Dorsal Root Ganglion Stimulation for Low Back Pain

Cited by 9 publications

References 61 publications

Three-Year Outcomes After Dorsal Root Ganglion Stimulation in the Treatment of Neuropathic Pain After Peripheral Nerve Injury of Upper and Lower Extremities

Three-Year Outcomes After Dorsal Root Ganglion Stimulation in the Treatment of Neuropathic Pain After Peripheral Nerve Injury of Upper and Lower Extremities

Dorsal Root Ganglion Stimulation for the Management of Chronic Neuropathic Pain: A Retrospective Case Series during Four Years follow-up in a Single Center

Exploration of the Supraspinal Hypotheses about Spinal Cord Stimulation and Dorsal Root Ganglion Stimulation: A Systematic Review

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