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.
Chapman KB, Tupper CJ, Amireh AA, van Helmond N, Yousef TA. Impact of lowering frequency of dorsal root ganglion stimulation on implantable pulse generator consumption. Reg Anesth Pain Med. Published online September 15, 2022. doi:10.1136/rapm-2022-103644