Unique Characteristics of the Dorsal Root Ganglion as a Target for Neuromodulation

Abstract

Objective The dorsal root ganglion (DRG) is a novel target for neuromodulation, and DRG stimulation is proving to be a viable option in the treatment of chronic intractable neuropathic pain. Although the overall principle of conventional spinal cord stimulation (SCS) and DRG stimulation—in which an electric field is applied to a neural target with the intent of affecting neural pathways to decrease pain perception—is similar, there are significant differences in the anatomy and physiology of the DRG that make it an ideal target for neuromodulation and may account for the superior outcomes observed in the treatment of certain chronic neuropathic pain states. This review highlights the anatomy of the DRG, its function in maintaining homeostasis and its role in neuropathic pain, and the unique value of DRG as a target in neuromodulation for pain. Methods A narrative literature review was performed. Results Overall, the DRG is a critical structure in sensory transduction and modulation, including pain transmission and the maintenance of persistent neuropathic pain states. Unique characteristics including selective somatic organization, specialized membrane characteristics, and accessible and consistent location make the DRG an ideal target for neuromodulation. Because DRG stimulation directly recruits the somata of primary sensory neurons and harnesses the filtering capacity of the pseudounipolar neural architecture, it is differentiated from SCS, peripheral nerve stimulation, and other neuromodulation options. Conclusions There are several advantages to targeting the DRG, including lower energy usage, more focused and posture-independent stimulation, reduced paresthesia, and improved clinical outcomes.

Peripheral Inflammatory Hyperalgesia Depends on P2X7 Receptors in Satellite Glial Cells

“…At the sensory ganglia resides the soma of nociceptors and other somesthetic neurons as well as specialized glial cells, the satellite glial cells (SGC). Besides the important role in metabolic support, events at DRG are known to participate in the development of pathological pain (Devor, 1999;Esposito et al, 2019). Primary afferent neurons at the DRG do not interact with one another through synaptic contact.…”

<p>Application and Therapeutic Effect of Puncturing of the Costal Transverse Process for Pulsed Radiofrequency Treated T1-T3 Herpes Zoster Neuralgia</p>

“…The postoperative PHN incidence rate is 4.55%, and this is similar to the previous reports both at home and abroad. 10 In summary, CT-guided puncture of the costal transverse process in the dorsal root ganglion with pulsed radiofrequency treatment of T1-T3 herpes zoster neuralgia demonstrated a high success rate and is considered to be safe and effective. This study provides a new technique guide for CT-guided puncture technology and also provides an effective reference for clinical treatment of patients with herpes zoster involving T1-T3 areas.…”

“…9 Recent clinical studies have revealed that pulsed radiofrequency treatment of dorsal root ganglion in managing herpes zoster neuralgia has achieved ideal therapeutic effects. [10][11][12] CT-guided dorsal root ganglion puncture is considered safe and accurate, and so it is widely used for treating PHN clinically, 13,14 However, it is worth mentioning that when herpes zoster is involved in the upper thoracic segment, especially in the area of dorsal root ganglion of T1-T3, CT-guided puncture often remains difficult due to blockage of the lamina, transverse process, and ribs. This not only prolongs the operation time, but also increases the patient's pain, making it difficult to obtain the expected operation results.…”

Intervertebral foramen injection of plerixafor attenuates CCD-induced low back&nbsp;pain&nbsp;in&nbsp;rats through down-regulation of Nav1.8 and Nav1.9

“…There are multiple changes in gene expression in DRG under pain condition, encompassing a large number of distinct family members including neuropeptides, receptors, ion channels, signal transduction molecules, synaptic vesicle proteins, and others [41,42]. The functional consequence of these changes is sensitization and hyperexcitability of DRG neurons, which then leads to persistent pain [18]. Moreover, the DRG is consistently locating at the intervertebral neural foramina within a capsule which is an easily accessible target.…”

“…Consequently, the abovementioned drug systemic administration modality will inevitably result in a number of adverse events and blur the action site of the plerixafor. Giving that the dorsal root ganglion (DRG) containing bodies of primary sensory neurons which may generate abnormal spontaneous discharges and become an important source of hyperexcitability and increased nociceptive signaling, the intervertebral foramen injection aiming at delivering drugs onto the DRG might be an appropriate alternative approach for drug delivery [16][17][18].…”