Very Low Frequencies Maintain Pain Relief From Dorsal Root Ganglion Stimulation: An Evaluation of Dorsal Root Ganglion Neurostimulation Frequency Tapering

Chapman, Kenneth B.; Yousef, Tariq; Vissers, Kris; Helmond, Noud van; Stanton‐Hicks, Michael

doi:10.1111/ner.13322

Cited by 26 publications

(31 citation statements)

References 43 publications

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“…These findings, combined with the observation that LTMR input has a strong analgesic effect at low firing frequencies but hardly affects pain behavior evoked at stimulation frequencies above 5 Hz (36), suggest that very low‐frequency DRG‐S may be optimal for pain relief while also being the most efficient for charge delivery. With DRG‐S, clinical therapeutic benefit occurs in the same low frequency range, from 4 to 20 Hz, achieving equivalent pain control to higher frequencies while limiting the electrical dose being utilized (8).…”

Section: Very Low‐frequency Drg‐s: Spinal Inhibitionmentioning

confidence: 99%

“…Our empirical observations in the clinic suggest that lower frequency stimulation may be as efficacious in DRG‐S: a retrospective analysis of 20 consecutive patients with low back pain maintained their pain relief after tapering their stimulation frequency to 4 Hz (8), which is the lowest device setting for the Proclaim DRG‐S system (9). Here, we review the literature to discuss the implications of these observations regarding a mechanism of action to explain the effectiveness of very low‐frequency DRG‐S for pain relief.…”

Section: Introductionmentioning

confidence: 99%

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Mechanisms for the Clinical Utility of Low-Frequency Stimulation in Neuromodulation of the Dorsal Root Ganglion

Chapman

Yousef

Foster

et al. 2021

Neuromodulation: Technology at the Neural Interface

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Section: Very Low‐frequency Drg‐s: Spinal Inhibitionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mechanisms for the Clinical Utility of Low-Frequency Stimulation in Neuromodulation of the Dorsal Root Ganglion

Chapman

Yousef

Foster

et al. 2021

Neuromodulation: Technology at the Neural Interface

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“…A similar rapid appearance of migrations was observed in SCS and improved with anchor placement. 3,4 DRG-S has been shown to significantly improve function, 11,12,28,29 and likely led to a restoration of activities and quality of life shortly after implantation.…”

Section: Migrationsmentioning

confidence: 99%

Lead migration and fracture rate in dorsal root ganglion stimulation using anchoring and non‐anchoring techniques: A multicenter pooled data analysis

et al. 2021

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Introduction: Dorsal root ganglion stimulation (DRG-S) is a neuromodulation technique introduced in the last decade with evolving implant methods. Initial prospective research found low incidences of lead migration and lead fracture with DRG-S. However, several recent studies have highlighted high lead migration and lead fracture rates with DRG-S. We investigated the influence of lead anchoring on migrations and fractures. Methods:We performed a retrospective review between 2016 and 2020 of individuals implanted with DRG-S leads by 4 experienced implanters. The implanters independently changed their standard practice regarding lead anchoring over time, with opposing trends (no anchoring > anchoring, anchoring > no anchoring). We compared lead migration and lead fracture rates between anchored and unanchored DRG-S leads in the entire study cohort. Cox regression was performed on lead migration and fracture distributions. Results:We included 756 leads (n = 565 anchored and n = 191 unanchored) from 249 patients. In unanchored leads, migration occurred in 16 leads (8.4%) from 13 patients (21.0%). In anchored leads, migration occurred in 8 leads (1.4%) from 5 patients (2.7%). Fracture in unanchored leads occurred in 6 leads (3.1%) from 6 patients (9.7%). Fractures in anchored leads occurred in 11 leads (1.9%) from 9 patients (4.8%). The migration survival distributions for the anchored and unanchored leads were statistically significantly different (p < 0.01) with decreased survival for unanchored leads (hazard ratio = 5.8, 95% confidence interval [CI] = 2.2-15.5). Discussion:We found that anchoring DRG-S leads significantly reduces lead migration when compared to leads placed without an anchor. There was no significant difference in fracture rate between anchored and unanchored leads.

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“…However, it is still possible to see a difference in the DRGS efficacy in awake subjects. For the DRGS parameters, we have assessed the efficacy of two different DRGS parameters (two frequencies with two different pulse widths) based on the previous study (Chapman et al, 2020) as the optimal parameter has not been elucidated yet. Further studies will be necessary to find the optimal DRGS parameters, especially in animal models of cardiac disease.…”

Section: Limitationsmentioning

confidence: 99%

Neuromodulation With Thoracic Dorsal Root Ganglion Stimulation Reduces Ventricular Arrhythmogenicity

et al. 2021

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Introduction: Sympathetic hyperactivity is strongly associated with ventricular arrhythmias and sudden cardiac death. Neuromodulation provides therapeutic options for ventricular arrhythmias by modulating cardiospinal reflexes and reducing sympathetic output at the level of the spinal cord. Dorsal root ganglion stimulation (DRGS) is a recent neuromodulatory approach; however, its role in reducing ventricular arrhythmias has not been evaluated. The aim of this study was to determine if DRGS can reduce cardiac sympathoexcitation and the indices for ventricular arrhythmogenicity induced by programmed ventricular extrastimulation. We evaluated the efficacy of thoracic DRGS at both low (20 Hz) and high (1 kHz) stimulation frequencies.Methods: Cardiac sympathoexcitation was induced in Yorkshire pigs (n = 8) with ventricular extrastimulation (S1/S2 pacing), before and after DRGS. A DRG-stimulating catheter was placed at the left T2 spinal level, and animals were randomized to receive low-frequency (20 Hz and 0.4 ms) or high-frequency (1 kHz and 0.03 ms) DRGS for 30 min. High-fidelity cardiac electrophysiological recordings were performed with an epicardial electrode array measuring the indices of ventricular arrhythmogenicity—activation recovery intervals (ARIs), electrical restitution curve (Smax), and Tpeak–Tend interval (Tp-Te interval).Results: Dorsal root ganglion stimulation, at both 20 Hz and 1 kHz, decreased S1/S2 pacing-induced ARI shortening (20 Hz DRGS −21±7 ms, Control −50±9 ms, P = 0.007; 1 kHz DRGS −13 ± 2 ms, Control −46 ± 8 ms, P = 0.001). DRGS also reduced arrhythmogenicity as measured by a decrease in Smax (20 Hz DRGS 0.5 ± 0.07, Control 0.7 ± 0.04, P = 0.006; 1 kHz DRGS 0.5 ± 0.04, Control 0.7 ± 0.03, P = 0.007), and a decrease in Tp-Te interval/QTc (20 Hz DRGS 2.7 ± 0.13, Control 3.3 ± 0.12, P = 0.001; 1 kHz DRGS 2.8 ± 0.08, Control; 3.1 ± 0.03, P = 0.007).Conclusions: In a porcine model, we show that thoracic DRGS decreased cardiac sympathoexcitation and indices associated with ventricular arrhythmogenicity during programmed ventricular extrastimulation. In addition, we demonstrate that both low-frequency and high-frequency DRGS can be effective neuromodulatory approaches for reducing cardiac excitability during sympathetic hyperactivity.

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Very Low Frequencies Maintain Pain Relief From Dorsal Root Ganglion Stimulation: An Evaluation of Dorsal Root Ganglion Neurostimulation Frequency Tapering

Cited by 26 publications

References 43 publications

Mechanisms for the Clinical Utility of Low-Frequency Stimulation in Neuromodulation of the Dorsal Root Ganglion

Mechanisms for the Clinical Utility of Low-Frequency Stimulation in Neuromodulation of the Dorsal Root Ganglion

Lead migration and fracture rate in dorsal root ganglion stimulation using anchoring and non‐anchoring techniques: A multicenter pooled data analysis

Neuromodulation With Thoracic Dorsal Root Ganglion Stimulation Reduces Ventricular Arrhythmogenicity

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