Dose Tapering of Dorsal Root Ganglion Stimulation Reduces Battery Consumption

A dose-tapering program for dorsal root ganglion stimulation (DRG-S) was found to decrease battery consumption of the implantable pulse generator (IPG) compared with standard programming, according to a research report published in Regional Anesthesia & Pain Medicine.

A recent advancement in neuromodulation for the treatment of chronic pain is the use of DRG-S; however, this strategy relies on an IPG that cannot be recharged. Once the IPG’s battery is sufficiently depleted, the patient must undergo surgical replacement. At implantation, IPGs carry a charge of ≥3.00 V. Once the charge reaches 2.73 V, the elective IPG replacement indicator alarm is activated. According to the manufacturer, the device should last for approximately 6.5 to 7 years.

Investigators report that “[r]ecent studies have shown that dose-tapering strategies for DRG-S using very low frequencies can provide equivalent therapeutic efficacy to standard program settings.” Therefore, to evaluate battery-sparing strategies, records from The Spine & Pain Institute of New York were retrospectively reviewed. Patients (N=106) who underwent DRG-S between 2017 and 2021 were assessed for battery consumption of the IPG on the basis of using dose-tapering (n=90) or standard (n=16) programming strategies. Dose tapering was defined as a lowering of the stimulation frequency over time.

The patient population consisted of 65% women, mean age was 60±13 years, 47% had failed back surgery syndrome, 24% had nonsurgical low back pain, 10% had complex regional pain syndrome, and 86% had leads at T12.

Patients who underwent dose tapering had a mean stimulation frequency of 6.9 Hz, pulse width of 257 µs, amplitude of 0.567 mA, and charge per second of 1.005 µC/s. Patients receiving a standard programming strategy had a mean stimulation frequency of 19.1 Hz, pulse width of 259 µs, amplitude of 0.492 mA, and charge per second of 2.434 µC/s.

After a mean of 671 days of treatment for the dose-tapering and 603 days of treatment for the standard cohorts, the remaining IPG charges were 2.988 V and 2.978 V, respectively. A remaining charge of ≥3.00 V was reported for 39% of patients in the dose-tapering group and for 6% of the patients receiving standard programming.

Stratified by duration of treatment, the patients with the longest use (>3 years; n=13), had an average remaining charge of 2.974 V, and 1 patient had a remaining charge of ≥3.00 V.

No patients underwent IPG replacement surgery during the study.

This study was limited by its retrospective design and imbalanced cohort sizes.

These data indicate that a tapered-dose strategy maintains IPG battery charge longer than a standard program among patients undergoing DRG-S for chronic pain.