Under normal circumstances, an injury such as a broken bone or sprained ankle will heal on its own with appropriate care such as casting, rest, elevation, etc. Once healed, there are generally no long-term effects. Or as some would say, “I’m as good as new.”
Sometimes, however, the thin fibers of nerves near the injured area may be affected and this can cause the body’s pain messaging to kick into overdrive. There may be spontaneous outbreaks of pain or pain that is triggered by something as mild as the touch of a bed sheet.
Pain medicine specialists refer to this as complex regional pain syndrome (CRPS).
Is My Foot and Ankle Pain due to CRPS?
Chronic pain in the feet and ankles can make it difficult to do even the simplest tasks: go to the grocery store, take the dog for a walk, check the mailbox.
When other causes of chronic foot and ankle pain have been ruled out—such as plantar fasciitis, fallen arches, etc.—a pain management specialist should be consulted. He or she will begin by asking if the patient suffered any kind of injury or trauma to the feet or ankles. More than 90 percent of CRPS cases are triggered by events such as:
- Bone Fractures
- Sprains/strains to connective tissues
- Limb immobilization (often from casting that is too tight)
- Surgery that results in scarring
- Injuries such as burns or cuts
What makes CRPS so frustrating to those who suffer from it is that although their initial injury has healed, the lingering pain continues to affect their daily lives.
Will the Pain Ever End?
Advances in pain management interventions are giving patients with CRPS new hope for life without pain.
Dorsal root ganglion (DRG) stimulation was approved by the FDA in 2016. This treatment is designed to intercept pain signals that originate in the bundle of nerve bodies called the dorsal root ganglion. These nerves control pain signals from the peripheral nervous system, the nerves that reach the body’s extremities such as the feet and ankles. The DRG nerves then relay these messages to the central nervous system, which includes the spinal cord and the brain.
DRG stimulation involves implanting a small neurostimulator under the skin near the DRG nerve bundle. This stimulator sends a mild electric current that overtakes the pain signals before they reach the central nervous system and the brain. The patient uses a small external remote to adjust the level of electrical stimulation to meet their particular needs.
Taking a Test Drive
If the pain management specialist believes DRG stimulation is an appropriate treatment option, he or she will first require the patient to take the stimulator for a “test drive” – or in medical terms, a trial.
During the trial, temporary leads and electrodes connected to the stimulation device are positioned at the DRG using fluoroscopic (x-ray) guidance, just as they would be for a permanent implant. The patient is given an external generator (usually worn on a belt) and is asked to log their pain for the next few days as they engage in a variety of physical activities. The pain management specialist will review this pain log with the patient and determine if permanent implantation is appropriate, since clinical evidence reveals that the majority of patients who obtain pain relief during the trial are solid candidates for permanent implants.
The permanent implant procedure is minimally invasive and performed on an out-patient basis. Because it involves just a small incision, most patients return to a normal routine within 24 hours. They are instructed on how to use the permanent implant’s small, external hand-held remote to adjust the level of stimulation to meet their pain needs.
Since its FDA-approval four years ago, DRG stimulation has demonstrated that when performed by highly trained pain medicine specialists, it combines the very best of technology with medical expertise. It can be an effective treatment option for especially challenging cases of complex regional pain syndrome, including those in the feet and ankles.[i][ii][iii]
Dr. Skaribas is recognized as a leader in the field of interventional pain medicine in Houston and is an expert in dorsal root ganglion stimulation to treat chronic pain in the extremities.