Dorsal Ganglion Root (DRG) Stimulator

Dorsal root ganglion (DRG) stimulation is a treatment that uses small electrical signals to target your dorsal root ganglion.

The dorsal root ganglion (DRG) is a group of sensory nerve cells. It sits just outside your spinal cord in a small opening in your spine. These nerve cells carry information about touch, temperature and pain. The DRG then passes that information to your spinal cord and brain, where you actually feel it.

Normally, the DRG helps you sense things like heat, cold or pressure. But if an illness or injury makes it overactive, it can keep sending pain signals even after your body heals. This can cause chronic pain (pain that lasts for months or longer).

A surgeon will implant a DRG stimulator device into your body. The device sends electrical pulses to calm the overactive DRG. This may reduce chronic pain by changing pain signals before they reach your brain.

What conditions does a DRG stimulator manage?

The U.S. Food and Drug Administration 9FDA) approved DRG stimulators to manage complex regional pain syndrome (CRPS) and causalgia in the lower limbs. These are nerve-related pain conditions.

Providers are also studying this treatment for the following conditions:

• Diabetes-related neuropathy
• Focal neuropathy
• Polyneuropathy

DRG stimulation surgery

DRG stimulation requires surgery to place a medical device in your body. This device sends electrical signals to the affected dorsal root ganglion.

Before surgery, your provider will do an exam and may order imaging tests. You’ll also get instructions to prepare, like stopping blood thinners, as they can increase the risk of bleeding.

This treatment happens in two steps:

1. Trial procedure: First, you’ll test the device. A surgeon places temporary leads (thin wires) near your DRG. These wires exit your body and connect to an external stimulator. You’ll try this for several days. If it reduces your pain by more than 50%, you’ll move on to the permanent implant.
2. Permanent procedure: Your provider removes the temporary device and implants a permanent one.

During DRG stimulation surgery, the steps usually include:

1. Receiving anesthesia: You’ll get deep sedation or general anesthesia.
2. Positioning: Your surgical team places you on your stomach.
3. Imaging scans: These guide your surgeon to the right spot.
4. Placing a needle: A special needle goes into the epidural space (just outside your spinal cord).
5. Placing a lead: A thin wire (lead) goes through the needle to the target area. This wire delivers electrical signals to the DRG.
6. Implanting the stimulator: A small device, about the size of a matchbox, goes under your skin. Your surgeon connects the lead to this device.
7. Testing: Your surgeon checks that the device works properly.
8. Closing and programming: Your surgeon stitches the incision site closed and programs the device.

What is the success rate of DRG stimulation?

Researchers found that many people get more than 50% pain relief with DRG stimulation. In one study, 63% of people had this level of relief after one year. Another study reported that 74% of people experienced similar results at the one-year mark.

Results vary from person to person. Your surgeon can give you a better idea of what to expect in your situation.

DRG stimulation benefits

The benefits of DRG stimulation may include:

• Focal coverage of the pain
• Better ability to do daily activities
• Another treatment option besides pain medicines

The treatment is also reversible. Your surgeon can remove the device at any time if needed.

DRG stimulation side effects

There are possible side effects from a DRG stimulator. These may include:

• Broken lead or lead movement
• Device site discomfort
• Infection after surgery
• Problems with the device working correctly
• Unusual tingling or sensations

Your surgical team will take steps to lower the risk of these problems.

DRG stimulator recovery

After surgery, you’ll have bandages covering the incision site. These usually stay on for a few days. Your care team will show you how to clean and care for them at home.

It’s normal to feel some pain, soreness, swelling or bruising at the stimulator site. Your care team will give you medicine to help with pain. You can also use ice packs wrapped in a towel to help reduce swelling.

Some people stay in the hospital right after surgery. Others go home the same day. Your surgeon will tell you what to expect in advance so you can plan.

You’ll need to take it easy while you recover. Avoid rapid twisting or excessive bending. Normal, light activities are usually fine. But avoid anything strenuous. Ask your provider which activities are safe before you do them.

You’ll also get instructions on how to use the stimulator’s remote. Like a TV remote, it lets you adjust the device settings under your provider’s guidance. At first, your provider will set up general settings. Over the next few weeks, they may adjust them to better fit your needs.

How long do DRG stimulator batteries last?

Battery life depends on the type of device you get. DRG devices last much longer than everyday electronics. Most last about six to seven years. A minor outpatient procedure allows your surgeon to access the implanted device and swap it out with a new one. The lead wires usually stay in place during this procedure.

The remote batteries need recharging much sooner than the device itself. But you can easily do this at home.

When should I call my healthcare provider?

Keep an eye on the incision site after surgery. Let your care team know if anything looks or feels unusual, like:

• Drainage or bleeding
• Fever
• Sharp, sudden or severe pain
• Skin discoloration
• Swelling that doesn’t go down
• Warmth

These could be signs of an infection.