How DRG Differs from SCS – The Idea of Pleasant Stimuli in CRPS
Written by Dr. Chu for the RSDSA blog.
As most patients suffering from Complex Regional Pain Syndrome know, long-term data regarding standard treatment for this oftentimes debilitating condition has been mediocre at best. In fact, most of the usual treatment available, until recently, have been extremely limited. Nerve-specific medications can have intolerable side effects and low responder rates. Injections such as sympathetic nerve blocks are typically short-lived. Even more advanced therapeutics such as Dorsal Column Stimulation (traditional SCS) have mixed results with patients reporting unwanted areas of stimulation or loss of pain relief over time.
The idea behind neuromodulation is simple, of course. Change the way our nervous system transmits pain signals by blocking it with low levels of electrical current delivered to the spinal cord via small implantable wires and replacing painful sensations with more pleasant ones, thereby giving patients relief. Traditional spinal cord stimulation has been used to treat a variety of chronic pain states. Originating back in, that late 1960s to treat refractory cancer pain, this technology has evolved to successfully help patients suffering from many different types of pain, including failed back surgery syndrome, chronic nerve pain, headaches, chronic pain that develops after trauma or surgery and many more, including CRPS.
I often tell my patients the simplest way to think about this it [is] to remember the last time you stubbed your toe. Between hopping on one leg and screaming at your furniture, you were probably also rubbing your toe. You instinctively do it because it makes your toe feel better. You are distracting your brain from the intense pain by introducing another type of sensation- the sensation of a nice massage.
But as I mentioned, traditional SCS is often not precise or targeted enough for patients with CRPS. Let’s say you suffer from complex regional pain syndrome of the foot that has been refractory to the usual conservative treatment. Spinal cord stimulation may be a reasonable option to treat the continuous pain in your foot, but you may also experience unwanted stimulation in other areas like your low back or thigh. Alternatively, doctors may be able to capture your painful areas with stimulation, but it may not provide durable pain relief.
Given these limitations with traditional SCS, pain physicians around the world have been so excited about Dorsal Root Ganglion Stimulation, a new, ground-breaking, novel treatment option for patients suffering from CRPS. Like traditional SCS, pain relief is achieved through an implantable medical device which delivers low levels of electricity. However, the primary difference is that physicians are now able to precisely place the stimulator leads to target specific areas of pain or damaged nerves, avoiding unwanted areas of stimulation. In addition, the therapy is “sub-threshold,” meaning pain relief is achieved without any paresthesia.
While this therapy has been available in other parts of the world for more than 5 years, the FDA only recently approve (Feb 2016) this treatment for the use in the US. Results from the U.S.-based ACCURATE study have recently been published. In comparing DRG stimulation to traditional SCS, the study found that after following CRPS patients for 12 months,
- More patients found pain relief with DRG stimulation (74%) when compared to SCS (53%)
- More patients reported better focused relief of their painful areas with DRG (95%) vs SCS (61%)
- More than 33% of patients in the study experienced 80% pain relief or better.
CRPS affects many patients in many different ways. More advanced treatments such as the ones discussed here may not be for everyone. However, if you or someone you know is suffering from CRPS, have undergone more conservative therapy without benefit, have significant functional limitations due to pain from CRPS, or continue to rely on high-doses of opiod therapy, DRG stimulation may be right for you.
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While I have had several surgeries and recently a couple of years ago a spinal fusion at L4-L5 which did not worked I have all been diagnosed with severe neuropathy in both feet, the pain radiates from the back down my legs and feet. I have been considering the trial for a Nevro H10 SCS but not sure this is right my neuropathy is so bad I would rather live with the back pain if I could get 70% or better pain relief in my feet. Can this be better as an option for me, please respond. Thank you Kindly.
I was diagnosed with IC of the bladder back in January 2018. I woke up one morning with the worst pain and I didn’t know what was going on! This Pain is WORSE than labor pains! I spent the ENTIRE year of 2018 in bed lying in a fetal position crying in pain! My urologist put a bladder stimulator in me that is suppose to help the urgency and frequency…..but it does NOT help the pain part of IC of the bladder! My urologist keeps telling me that there is nothing out there that helps with pain for IC (interstitial cystitis) of the bladder. I had him refer me to a pain doctor…..the first procedure he did on me was a Pudendal Nerve block….it didn’t help….the second procedure he did on me was Radio frequency nerve ablation…..that didn’t help! So now he’s going to try the 1 week trial DRG stimulator on September 17th! I sure hope this works because you have NO quality of life with IC of the bladder! It has RUINED my life and has affected my marriage! Some women have taken their own life because they can’t deal with the pain anymore and that is sad! BCBS DENIED this DRG Stimulator! Can you believe that! My pain doctor had to call BCBS and speak with a medical director and told him that I needed this done! The medical director approved it! Shame on insurance companies that deny this procedure!! We pay enough for medical insurance and they denied this procedure?? Hoping this DRG Stimulator helps! If this doesn’t, I’m throwing in the towel and I’m DONE with procedures, doctor after doctors and NONE of the oral medications helped at all! I am beginning to wonder if it’s even IC of the bladder that I have!
Please put me on your mailing list! I would appreciate that very much!
Please put me on your mailing list. I just had a scs put in in Dec.19 for permanent nerve damage in my right buttocks, leg, foot, toes… it’s made me worse and now it’s moved to parts of my left leg. Now I have a new pain in my thoracic area from the laminectomy that no one told me I was getting until the day of surgery. I also have permanent nerve damage from my c7 surgery/injury?? And I’m pretty much numb from head to toe. When I went to my neurosurgeon he told me to turn the stimulator off for a month, when I reached out to my rep she agreed and said sorry you didn’t get any relief… I’m hot because I inquired about a drg and they told me no, that the scs was better for my issues… not what I have learned since this hell started. Ty !!
Hello, Tonya! Please sign up at https://rsds.insctest1.com/joinmembership!
Thank you Doc for sharing this post and you have made it pretty clear that DRG is more reliable than SCS for pain relief.
I have had a trial SCS implant that did not help. My pain starts in lower left back and then goes to left leg with burning sensation. Maybe DRG is what I need?
I suffer from CRPS and was just about to have an SCS implanted prior to discovering DRG simulator option. Please include me in your mailing list and any additional information you might be able to provide me. Thanks so much in advance for any and all help regarding this most important matter in my life!
Will do, Jay!