Successful Dorsal Root Ganglion Stimulation for Chronic Pancreatitis: A Case Report

Abstract

Chronic pancreatitis represents an inflammatory condition occurring from repetitive pancreatic inflammation episodes ultimately causing patients intractable pain alongside pancreatic insufficiency and as a result, reduced quality of life. In addition to alcohol and smoking cessation, patients with chronic pancreatitis are treated conservatively with anti-depressants, anti-convulsant and analgesic medications including paracetamol and celecoxib -with limited success. Alternative to surgical resection, patients can opt for endoscopic treatment options including sphincterotomy or removal of calculi which have shown limited success. Celiac plexus blocks have had positive outcomes as well, however, are not long-lasting and carry significant risks, such as gastroparesis or organ damage. Evidence has shown alterations in the peripheral and central nervous system which causes these patients to often experience dysfunctional and neuropathic pain. The advent of this knowledge has introduced neuromodulation into the field with successful cases of spinal cord stimulation treating the pain associated with chronic pancreatitis. Dorsal root ganglion stimulation is similarly based upon the gate theory of pain but with more precision as it strictly targets the dorsal root ganglion. There have been no cases reported in the literature of this form of stimulation in treating chronic pancreatitis. We present a case of a patient with chronic pancreatitis who obtained 80% abdominal pain relief for two years after undergoing dorsal root ganglion stimulation.

Recent advances in the understanding and management of chronic pancreatitis pain

“…There are also rare reports in which spinal cord or dorsal root ganglion stimulation has been used. [119][120][121] However, evidence for efficacy of these procedures is inconclusive and these procedures are not universally recommended given risks and perceived lack of durable benefit. [3,66]…”