Some chronic neuropathic pain defies explanation. Why is there often pain after amputation for so long? Another condition known as complex regional pain syndrome (CRPS) is just that—complex. With CRPS, the nervous system reacts to an injury with wildly disproportionate symptoms. Needless to say, designing a treatment plan for CRPS can be very, well, complex.
DRG Spinal Stimulation
Signs of CRPS can include allodynic ( pain to touch), hypersensitive, or swollen arms and legs; severely fluctuating skin temperature; sensitivity to cold and touch; muscular contractions; tingling or burning sensations. Most of all, those with CRPS suffer almost unremitting, excessive pain.
For patients with these types of conditions, Dr. Skaribas has met with success using a new type of therapy called dorsal root ganglion (DRG) stimulation, approved by the FDA in 2016.*
A bundle of nerve cell bodies in the posterior region of various vertebrae along the spinal column, the dorsal root ganglion sends signals from the peripheral nervous system to the central nervous system, which includes the spinal cord and the brain.
Mounting evidence over the years has supported the hypothesis that nerves are capable of carrying two signals at once. With DRG spinal stimulation, a neural message of pain on its way to the brain is overtaken and canceled out by a competing message, a mild electric current from a neurostimulator implanted in the patient’s dorsal root ganglion.*
Similar to a pacemaker, a neurostimulator is quite small and unobtrusive, and is placed just under the skin. Leads, insulated wires, are connected to the stimulation device as well as electrodes specially designed for use on this type of nerve bundle.
Testing the Waters
Again, as with a pacemaker, a trial run is standard protocol to make certain that DRG spinal stimulation is going to be an effective solution for the patient. The device’s temporary leads and electrodes are fluoroscopically positioned just as they would be for a permanent implant, but are connected to an external generator (usually worn on a belt). For the next several days, the patient needs to engage in a variety of physical activities to test how well the device works whenever he or she experiences pain. It’s critical at this juncture that that a careful log is kept of each activity along with the level of pain relief that comes from utilizing the temporary device.
Only after Dr. Skaribas reviews this log in detail and discusses the results carefully with a patient can he make a decision whether to proceed with permanent implantation.*
Escape From Pain
Those whose pain is improved by at least half during the trial run have a fighting chance that a permanent DRG spinal stimulation device will provide long-term relief.* The final procedure is minimally invasive and most patients return to a normal routine within 24 hours. Care should be taken to protect the incision site, which will be a little sore while it finishes healing.*
After that, patients are in the driver’s seat: the remote allow users to turn the system on or off, and to finesse the level of electrical stimulation to meet their particular needs and preferences.* As always, Dr. Skaribas and his staff will be on hand to offer advice or instruction.
Dr. Skaribas performing a Dorsal Root Ganglion Implantation for an amputee suffering from Phantom Limp pain. After the procedure the patient was completely pain free.