For certain patients with complex pain patterns, stimulating both dorsal root ganglion (DRG) and dorsal columns may relieve pain effectively, according to a case study presented at the American Academy of Pain Medicine 2019 annual meeting, held March 6-10, in Denver, Colorado.
DRG stimulation has been approved by the US Food and Drug Administration for the management of complex regional pain syndrome, and dorsal column stimulation is used for the management of chronic pain in the trunk or limbs.
In this case study, a 34-year-old United States Army soldier was treated at a level 1 trauma center. The patient had failed back surgery syndrome, which manifested in a complex pain pattern. He had a history of prior anterior and posterior L5-S1 interbody fusions complicated by the development of persistent, debilitating lower back pain, bilateral radicular pain in the S1 distribution, and groin pain.
The patient underwent DRG stimulation trial with bilateral L1 stimulation for groin pain, L2 stimulation for lower back pain, and S2 stimulation for radicular pain. This approach led to a 90% reduction in groin pain but did not alleviate pain in the lower back region or pain of radicular origin.
The patient was then treated with 2 additional stimulation trial leads targeting dorsal columns and placed at T8-9. This resulted in 80% pain relief for the patient’s remaining symptoms. The dorsal column stimulator was implanted in the patient to control the lower back and radicular pain with bilateral L1 and S2 DRG to control the groin pain.
Reed J, Timchenko AA, McCallin JP. Combined dorsal column and dorsal root ganglion stimulation for treatment of complex pain in a patient with failed back surgery syndrome. Presented at: the American Academy of Pain Medicine 2019 annual meeting; March 6-10, 2019; Denver, CO. Abstract 187.