Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and causalgia at 3 and 12 months: a randomized comparative trial
Timothy R. Deer,Robert M. Levy,Jeffery M. Kramer,Lawrence Poree,Kasra Amirdelfan,Eric Grigsby,Peter S. Staats,Allen W. Burton,Abram H. Burgher,Jon B. Obray,James Scowcroft,Stan Golovac,Leonardo Kapural,Richard Paicius,Christopher Kim,Jason E. Pope,Thomas L. Yearwood,Sam Samuel,W. Porter McRoberts,Hazmer Cassim,Mark D. Netherton,Nathan Miller,Michael Schaufele,Edward Tavel,Tim R.C. Davis,Kristina Davis,Linda Johnson,Nagy Mekhail +27 more
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The ACCURATE trial as discussed by the authors showed that DRG stimulation provided a higher rate of treatment success with less postural variation in paresthesia intensity compared to spinal cord stimulation.Abstract:
Animal and human studies indicate that electrical stimulation of dorsal root ganglion (DRG) neurons may modulate neuropathic pain signals. ACCURATE, a pivotal, prospective, multicenter, randomized comparative effectiveness trial, was conducted in 152 subjects diagnosed with complex regional pain syndrome or causalgia in the lower extremities. Subjects received neurostimulation of the DRG or dorsal column (spinal cord stimulation, SCS). The primary end point was a composite of safety and efficacy at 3 months, and subjects were assessed through 12 months for long-term outcomes and adverse events. The predefined primary composite end point of treatment success was met for subjects with a permanent implant who reported 50% or greater decrease in visual analog scale score from preimplant baseline and who did not report any stimulation-related neurological deficits. No subjects reported stimulation-related neurological deficits. The percentage of subjects receiving ≥50% pain relief and treatment success was greater in the DRG arm (81.2%) than in the SCS arm (55.7%, P < 0.001) at 3 months. Device-related and serious adverse events were not different between the 2 groups. Dorsal root ganglion stimulation also demonstrated greater improvements in quality of life and psychological disposition. Finally, subjects using DRG stimulation reported less postural variation in paresthesia (P < 0.001) and reduced extraneous stimulation in nonpainful areas (P = 0.014), indicating DRG stimulation provided more targeted therapy to painful parts of the lower extremities. As the largest prospective, randomized comparative effectiveness trial to date, the results show that DRG stimulation provided a higher rate of treatment success with less postural variation in paresthesia intensity compared to SCS.read more
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Spinal Cord Stimulation: Clinical Efficacy and Potential Mechanisms.
TL;DR: Novel, non‐standard, stimulation waveforms such as high‐frequency and burst have been shown in some studies to be clinically superior to conventional SCS, however their mechanisms of action remain to be determined.
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Pharmacological and non-pharmacological treatments for neuropathic pain: Systematic review and French recommendations.
Xavier Moisset,Didier Bouhassira,J. Avez Couturier,Haiel Alchaar,S. Conradi,M.-H. Delmotte,Michel Lantéri-Minet,Jean-Pascal Lefaucheur,G. Mick,Virginie Piano,G. Pickering,E. Piquet,C. Regis,E. Salvat,Nadine Attal +14 more
TL;DR: A systematic review of pharmacotherapy, neurostimulation, surgery, psychotherapies and other types of therapy for peripheral or central neuropathic pain, based on studies published in peer-reviewed journals before January 2018, concludes that psychotherapy (cognitive behavioral therapy and mindfulness) is recommended as a second-line therapy, as an add-on to other therapies.
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Neuromodulation for chronic pain.
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TL;DR: In this article, the authors focus on spinal cord stimulation (SCS) therapies discussed within the framework of other invasive, minimally invasive, and non-invasive neuromodulation therapies.
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Unique Characteristics of the Dorsal Root Ganglion as a Target for Neuromodulation.
TL;DR: There are several advantages to targeting the DRG, including lower energy usage, more focused and posture-independent stimulation, reduced paresthesia, and improved clinical outcomes.
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Complex regional pain syndrome: a narrative review for the practising clinician.
TL;DR: This work reviews recent developments in the understanding of CRPS and advancements in management of this syndrome and suggests that further research in targeting specific mechanisms involved in the pathophysiology ofCRPS should lead to prevention of this condition.
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