Three‐Year Outcomes After Dorsal Root Ganglion Stimulation in the Treatment of Neuropathic Pain After Peripheral Nerve Injury of Upper and Lower Extremities
Objectives Traumatic peripheral nerve injuries (PNI) often result in severe neuropathic pain which typically becomes chronic, is recalcitrant to common analgesics, and is associated with sleep disturbances, anxiety, and depression. Pharmacological treatments proven to be effective against neuropathi...
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| Veröffentlicht in: | Neuromodulation (Malden, Mass.) Mass.), 2021-06, Vol.24 (4), p.700-707 |
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| creator | Kretzschmar, Michael Reining, Marco Schwarz, Marcus A. |
| description | Objectives
Traumatic peripheral nerve injuries (PNI) often result in severe neuropathic pain which typically becomes chronic, is recalcitrant to common analgesics, and is associated with sleep disturbances, anxiety, and depression. Pharmacological treatments proven to be effective against neuropathic pain are not well tolerated due to side effects. Neuromodulative interventions such as peripheral nerve or spinal cord stimulation have generated mixed results and may be limited by reduced somatotopic specificity. Dorsal root ganglion (DRG) stimulation may be more effective in this etiology.
Materials and Methods
Twenty‐seven patients were trialed with a DRG neurostimulation system for PNI; trial success (defined as ≥50% pain relief) was 85%, and 23 patients received a permanent stimulator. However, 36‐month outcome data was only available for 21 patients. Pain, quality of life, mental and physical function, and opioid usage were assessed at baseline and at 3‐, 6‐, 12‐, 18‐, 24‐, and 36 months post‐permanent implant. Implant‐related complications were also documented.
Results
Compared to baseline, we observed a significant pain relief (p |
| doi_str_mv | 10.1111/ner.13222 |
| format | Article |
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Traumatic peripheral nerve injuries (PNI) often result in severe neuropathic pain which typically becomes chronic, is recalcitrant to common analgesics, and is associated with sleep disturbances, anxiety, and depression. Pharmacological treatments proven to be effective against neuropathic pain are not well tolerated due to side effects. Neuromodulative interventions such as peripheral nerve or spinal cord stimulation have generated mixed results and may be limited by reduced somatotopic specificity. Dorsal root ganglion (DRG) stimulation may be more effective in this etiology.
Materials and Methods
Twenty‐seven patients were trialed with a DRG neurostimulation system for PNI; trial success (defined as ≥50% pain relief) was 85%, and 23 patients received a permanent stimulator. However, 36‐month outcome data was only available for 21 patients. Pain, quality of life, mental and physical function, and opioid usage were assessed at baseline and at 3‐, 6‐, 12‐, 18‐, 24‐, and 36 months post‐permanent implant. Implant‐related complications were also documented.
Results
Compared to baseline, we observed a significant pain relief (p < 0.001) at 3 (58%), 12 (66%), 18 (69%), 24 (71%), and 36 months (73%) in 21 patients (52.5 ± 14.2 years; 12 female), respectively. Mental and physical function showed immediate and sustained improvements. Participants reported improvements in quality of life. Opioid dosage reduced significantly (p < 0.001) at 3 (30%), 12 (93%), 18 (98%), 24 (99%), and 36 months (99%), and 20 of 21 patients were completely opioid‐free after 36 months. There were five lead migrations and two electrode fractures (corrected by surgical intervention) and one wound infection (conservatively managed).
Conclusions
DRG neuromodulation appears to be a safe, effective, and durable option for treating neuropathic pain caused by PNI. The treatment allows cessation of often ineffective pharmacotherapy (including opioid misuse) and significantly improves quality of life.</description><identifier>ISSN: 1094-7159</identifier><identifier>EISSN: 1525-1403</identifier><identifier>DOI: 10.1111/ner.13222</identifier><identifier>PMID: 32573868</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Analgesics ; Chronic neuropathic pain ; Dorsal root ganglia ; dorsal root ganglion stimulation ; Dosage ; Drug therapy ; Etiology ; Female ; Fractures ; Ganglia, Spinal ; Humans ; Injuries ; Lower Extremity ; Narcotics ; Neuralgia - etiology ; Neuralgia - therapy ; Neuromodulation ; opioid misuse peripheral nerve injury quality of life ; Opioids ; Pain ; Peripheral Nerve Injuries ; Peripheral nerves ; Peripheral neuropathy ; Quality of Life ; Spinal cord ; Spinal Cord Stimulation ; Treatment Outcome ; Wound infection</subject><ispartof>Neuromodulation (Malden, Mass.), 2021-06, Vol.24 (4), p.700-707</ispartof><rights>2020 The Authors. published by Wiley Periodicals LLC. on behalf of International Neuromodulation Society.</rights><rights>2020 The Authors. Neuromodulation: Technology at the Neural Interface published by Wiley Periodicals LLC. on behalf of International Neuromodulation Society.</rights><rights>2020. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4582-d34d42dc797ca6d4693dd4f2089856e46b75714a107713441a665b4d23a8d2cb3</citedby><cites>FETCH-LOGICAL-c4582-d34d42dc797ca6d4693dd4f2089856e46b75714a107713441a665b4d23a8d2cb3</cites><orcidid>0000-0002-3233-801X ; 0000-0003-1755-7465</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32573868$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kretzschmar, Michael</creatorcontrib><creatorcontrib>Reining, Marco</creatorcontrib><creatorcontrib>Schwarz, Marcus A.</creatorcontrib><title>Three‐Year Outcomes After Dorsal Root Ganglion Stimulation in the Treatment of Neuropathic Pain After Peripheral Nerve Injury of Upper and Lower Extremities</title><title>Neuromodulation (Malden, Mass.)</title><addtitle>Neuromodulation</addtitle><description>Objectives
Traumatic peripheral nerve injuries (PNI) often result in severe neuropathic pain which typically becomes chronic, is recalcitrant to common analgesics, and is associated with sleep disturbances, anxiety, and depression. Pharmacological treatments proven to be effective against neuropathic pain are not well tolerated due to side effects. Neuromodulative interventions such as peripheral nerve or spinal cord stimulation have generated mixed results and may be limited by reduced somatotopic specificity. Dorsal root ganglion (DRG) stimulation may be more effective in this etiology.
Materials and Methods
Twenty‐seven patients were trialed with a DRG neurostimulation system for PNI; trial success (defined as ≥50% pain relief) was 85%, and 23 patients received a permanent stimulator. However, 36‐month outcome data was only available for 21 patients. Pain, quality of life, mental and physical function, and opioid usage were assessed at baseline and at 3‐, 6‐, 12‐, 18‐, 24‐, and 36 months post‐permanent implant. Implant‐related complications were also documented.
Results
Compared to baseline, we observed a significant pain relief (p < 0.001) at 3 (58%), 12 (66%), 18 (69%), 24 (71%), and 36 months (73%) in 21 patients (52.5 ± 14.2 years; 12 female), respectively. Mental and physical function showed immediate and sustained improvements. Participants reported improvements in quality of life. Opioid dosage reduced significantly (p < 0.001) at 3 (30%), 12 (93%), 18 (98%), 24 (99%), and 36 months (99%), and 20 of 21 patients were completely opioid‐free after 36 months. There were five lead migrations and two electrode fractures (corrected by surgical intervention) and one wound infection (conservatively managed).
Conclusions
DRG neuromodulation appears to be a safe, effective, and durable option for treating neuropathic pain caused by PNI. The treatment allows cessation of often ineffective pharmacotherapy (including opioid misuse) and significantly improves quality of life.</description><subject>Analgesics</subject><subject>Chronic neuropathic pain</subject><subject>Dorsal root ganglia</subject><subject>dorsal root ganglion stimulation</subject><subject>Dosage</subject><subject>Drug therapy</subject><subject>Etiology</subject><subject>Female</subject><subject>Fractures</subject><subject>Ganglia, Spinal</subject><subject>Humans</subject><subject>Injuries</subject><subject>Lower Extremity</subject><subject>Narcotics</subject><subject>Neuralgia - etiology</subject><subject>Neuralgia - therapy</subject><subject>Neuromodulation</subject><subject>opioid misuse peripheral nerve injury quality of life</subject><subject>Opioids</subject><subject>Pain</subject><subject>Peripheral Nerve Injuries</subject><subject>Peripheral nerves</subject><subject>Peripheral neuropathy</subject><subject>Quality of Life</subject><subject>Spinal cord</subject><subject>Spinal Cord Stimulation</subject><subject>Treatment Outcome</subject><subject>Wound infection</subject><issn>1094-7159</issn><issn>1525-1403</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNp1kUFu1DAUhiMEoqXtggsgS2zoIq3tOHayrMq0VBpNq3a66MryxC-MR4md2g5ldhyBE3A4ToKHFBZIePP-xfc-W_6z7C3BJySdUwv-hBSU0hfZPilpmROGi5cp45rlgpT1XvYmhA3GRNRUvM72ClqKouLVfvZjufYAP799fwDl0fUYG9dDQGdtBI8-Oh9Uh26di-hS2c-dcRbdRdOPnYq7bCyKa0BLDyr2YCNyLVrA6N2g4to06EYlYnLdgDfDGnzyLcB_AXRlN6Pf7jbuhyEBymo0d08pzb5GD72JBsJh9qpVXYCj53mQ3V_Mluef8vn15dX52TxvWFnRXBdMM6obUYtGcc14XWjNWoqruio5ML4SpSBMESwEKRgjivNyxTQtVKVpsyoOsg-Td_DucYQQZW9CA12nLLgxSMoIpzx9GUvo-3_QjRu9Ta-TtGQMc5yuTdTxRDXeheChlYM3vfJbSbDclSZTafJ3aYl992wcVz3ov-SflhJwOgFPpoPt_01yMbudlL8Aci2iLA</recordid><startdate>202106</startdate><enddate>202106</enddate><creator>Kretzschmar, Michael</creator><creator>Reining, Marco</creator><creator>Schwarz, Marcus A.</creator><general>John Wiley & Sons, Inc</general><general>Elsevier Limited</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3233-801X</orcidid><orcidid>https://orcid.org/0000-0003-1755-7465</orcidid></search><sort><creationdate>202106</creationdate><title>Three‐Year Outcomes After Dorsal Root Ganglion Stimulation in the Treatment of Neuropathic Pain After Peripheral Nerve Injury of Upper and Lower Extremities</title><author>Kretzschmar, Michael ; Reining, Marco ; Schwarz, Marcus A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4582-d34d42dc797ca6d4693dd4f2089856e46b75714a107713441a665b4d23a8d2cb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Analgesics</topic><topic>Chronic neuropathic pain</topic><topic>Dorsal root ganglia</topic><topic>dorsal root ganglion stimulation</topic><topic>Dosage</topic><topic>Drug therapy</topic><topic>Etiology</topic><topic>Female</topic><topic>Fractures</topic><topic>Ganglia, Spinal</topic><topic>Humans</topic><topic>Injuries</topic><topic>Lower Extremity</topic><topic>Narcotics</topic><topic>Neuralgia - etiology</topic><topic>Neuralgia - therapy</topic><topic>Neuromodulation</topic><topic>opioid misuse peripheral nerve injury quality of life</topic><topic>Opioids</topic><topic>Pain</topic><topic>Peripheral Nerve Injuries</topic><topic>Peripheral nerves</topic><topic>Peripheral neuropathy</topic><topic>Quality of Life</topic><topic>Spinal cord</topic><topic>Spinal Cord Stimulation</topic><topic>Treatment Outcome</topic><topic>Wound infection</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kretzschmar, Michael</creatorcontrib><creatorcontrib>Reining, Marco</creatorcontrib><creatorcontrib>Schwarz, Marcus A.</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Neuromodulation (Malden, Mass.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kretzschmar, Michael</au><au>Reining, Marco</au><au>Schwarz, Marcus A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Three‐Year Outcomes After Dorsal Root Ganglion Stimulation in the Treatment of Neuropathic Pain After Peripheral Nerve Injury of Upper and Lower Extremities</atitle><jtitle>Neuromodulation (Malden, Mass.)</jtitle><addtitle>Neuromodulation</addtitle><date>2021-06</date><risdate>2021</risdate><volume>24</volume><issue>4</issue><spage>700</spage><epage>707</epage><pages>700-707</pages><issn>1094-7159</issn><eissn>1525-1403</eissn><abstract>Objectives
Traumatic peripheral nerve injuries (PNI) often result in severe neuropathic pain which typically becomes chronic, is recalcitrant to common analgesics, and is associated with sleep disturbances, anxiety, and depression. Pharmacological treatments proven to be effective against neuropathic pain are not well tolerated due to side effects. Neuromodulative interventions such as peripheral nerve or spinal cord stimulation have generated mixed results and may be limited by reduced somatotopic specificity. Dorsal root ganglion (DRG) stimulation may be more effective in this etiology.
Materials and Methods
Twenty‐seven patients were trialed with a DRG neurostimulation system for PNI; trial success (defined as ≥50% pain relief) was 85%, and 23 patients received a permanent stimulator. However, 36‐month outcome data was only available for 21 patients. Pain, quality of life, mental and physical function, and opioid usage were assessed at baseline and at 3‐, 6‐, 12‐, 18‐, 24‐, and 36 months post‐permanent implant. Implant‐related complications were also documented.
Results
Compared to baseline, we observed a significant pain relief (p < 0.001) at 3 (58%), 12 (66%), 18 (69%), 24 (71%), and 36 months (73%) in 21 patients (52.5 ± 14.2 years; 12 female), respectively. Mental and physical function showed immediate and sustained improvements. Participants reported improvements in quality of life. Opioid dosage reduced significantly (p < 0.001) at 3 (30%), 12 (93%), 18 (98%), 24 (99%), and 36 months (99%), and 20 of 21 patients were completely opioid‐free after 36 months. There were five lead migrations and two electrode fractures (corrected by surgical intervention) and one wound infection (conservatively managed).
Conclusions
DRG neuromodulation appears to be a safe, effective, and durable option for treating neuropathic pain caused by PNI. The treatment allows cessation of often ineffective pharmacotherapy (including opioid misuse) and significantly improves quality of life.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>32573868</pmid><doi>10.1111/ner.13222</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-3233-801X</orcidid><orcidid>https://orcid.org/0000-0003-1755-7465</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Analgesics Chronic neuropathic pain Dorsal root ganglia dorsal root ganglion stimulation Dosage Drug therapy Etiology Female Fractures Ganglia, Spinal Humans Injuries Lower Extremity Narcotics Neuralgia - etiology Neuralgia - therapy Neuromodulation opioid misuse peripheral nerve injury quality of life Opioids Pain Peripheral Nerve Injuries Peripheral nerves Peripheral neuropathy Quality of Life Spinal cord Spinal Cord Stimulation Treatment Outcome Wound infection |
| title | Three‐Year Outcomes After Dorsal Root Ganglion Stimulation in the Treatment of Neuropathic Pain After Peripheral Nerve Injury of Upper and Lower Extremities |
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