Abstract
BackgroundThe influence of the stimulation frequency on the outcomes of dorsal root ganglion stimulation (DRG-S) to treat pain is not well understood. It is assumed that specific neural components dedicated to different tasks in the DRG can be preferably influenced at specific frequencies. The identification of frequencies designed for the type of pain and the ratio of neuropathic versus nociceptive pain might improve overall pain control and open new indications in DRG-S.MethodWe report on a randomized double-blind clinical trial with a crossover design. Patients with a permanent DRG-S system underwent phases of stimulation with 20 Hz, 40 Hz, 60 Hz, 80 Hz, and sham in a randomized order. Each phase lasted for 4 days and was followed by a 2-day washout period. Pain intensity and quality of life were assessed with visual analog scale (VAS), McGill Pain Questionnaire (MPQ), EQ-5D, and Beck Depression Inventory (BDI). Analgesics intake was assessed.ResultsOverall 19 patients were included in the study. CRPS was the most frequent pain etiology (7). Five patients had a PainDetect score of 12 or lower at baseline. The mean VAS before the system was implanted was 8.6 and 3.9 at the baseline. Pain intensity was reduced to 3.7 by the stimulation with 20 Hz but increased with higher frequencies reaching 5.8 at 80 Hz. A significant difference among the groups was shown over all variables examined (VAS, MPQ, EQ-5D, BDI). The best results were seen at 20 Hz for all variables, including the smallest increase in pain medication consumption.ConclusionsThe choice of the stimulation frequency shows a clear influence on pain reduction and quality of life. Lower stimulation frequencies seem to be most effective in neuropathic pain. Further studies are required to determine whether specific frequencies should be preferred based on the condition treated.
Highlights
Dorsal root ganglion (DRG) stimulation has been effectively used in the treatment of neuropathic pain of different etiologies
A significant difference among the groups was shown over all variables examined (VAS, McGill Pain Questionnaire (MPQ), EQ-5D, Beck Depression Inventory (BDI))
The choice of the stimulation frequency shows a clear influence on pain reduction and quality of life
Summary
Dorsal root ganglion (DRG) stimulation has been effectively used in the treatment of neuropathic pain of different etiologies. Spontaneous firing as a consequence of lower action potential thresholds can be observed in the DRG neurons [12]. Different stimulation frequencies could lower this abnormal activity with different intensities by readjusting the action potential threshold. Recent studies have shown that DRG-S with lower frequencies—and with lower total energy delivery—could be an effective alternative. A sub-analysis of the ACCURATE study [3] reported paresthesia-free subjects using DRG-S that achieved similar pain relief with lower amplitudes and frequencies [10]. The influence of the stimulation frequency on the outcomes of dorsal root ganglion stimulation (DRG-S) to treat pain is not well understood. It is assumed that specific neural components dedicated to different tasks in the DRG can be preferably influenced at specific frequencies. The identification of frequencies designed for the type of pain and the ratio of neuropathic versus nociceptive pain might improve overall pain control and open new indications in DRG-S
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
