Dorsal Root Ganglion (DRG) Stimulation in the Treatment of Phantom Limb Pain (PLP).
OBJECTIVES
Phantom limb pain (PLP) is a neuropathic condition in which pain is perceived as arising from an amputated limb. PLP is distinct from, although associated with, pain in the residual limb and nonpainful phantom sensations of the missing limb. Its treatment is extremely challenging; pharmaceutical options, while commonly employed, may be insufficient or intolerable. Neuromodulatory interventions such as spinal cord stimulation have generated mixed results and may be limited by poor somatotopic specificity. It was theorized that dorsal root ganglion (DRG) neuromodulation may be more effective.


MATERIALS AND METHODS
Patients trialed a DRG neurostimulation system for their PLP and were subsequently implanted if results were positive. Retrospective chart review was completed, including pain ratings on a 100-mm visual analogue scale (VAS) and patient-reported outcomes.


RESULTS
Across eight patients, the average baseline pain rating was 85.5 mm. At follow-up (mean of 14.4 months), pain was rated at 43.5 mm. Subjective ratings of quality of life and functional capacity improved. Some patients reduced or eliminated pain medications. Patients reported precise concordance of the paresthesia with painful regions, including in their phantom limbs; in one case, stimulation eliminated PLP as well as nonpainful phantom sensations. Three patients experienced a diminution of pain relief, despite good initial outcomes.


CONCLUSIONS
DRG neuromodulation may be an effective tool in treating this pain etiology. Clinical outcomes in this report support recent converging evidence suggesting that the DRG may be the site of PLP generation and/or maintenance. Further research is warranted to elucidate mechanisms and optimal treatment pathways.
['Eldabe|Sam|S|', 'Burger|Katja|K|', 'Moser|Heinrich|H|', 'Klase|Daniel|D|', 'Schu|Stefan|S|', 'Wahlstedt|Anders|A|', 'Vanderick|Bernard|B|', 'Francois|Eric|E|', 'Kramer|Jeffery|J|', 'Subbaroyan|Jeyakumar|J|']
D000328:Adult D000368:Aged D004599:Electric Stimulation Therapy D005260:Female D005471:Fluoroscopy D005500:Follow-Up Studies D005727:Ganglia, Spinal D006801:Humans D008297:Male D008875:Middle Aged D010591:Phantom Limb D012189:Retrospective Studies D016896:Treatment Outcome D064232:Visual Analog Scale
dorsal root ganglion (DRG) Chronic pain deafferentation neuropathic pain spinal cord stimulation (SCS) visual analog scale (VAS)