Subsequent publications examining DRG stimulation have continued to replicate the success reported in the ACCURATE study, thus showing the durability and reproducibility of this therapy. Since then, DRG stimulation has continued to be successful in the treatment of CRPS as well as a variety of other focal, postsurgical, neuropathic pain syndromes like post-herniorrhaphy neuralgia, phantom limb pain, and persistent pain after total joint replacement. DRG stimulation was approved for use in the United States by the Food and Drug Administration in 2015 for patients with chronic intractable pain of the lower limbs associated with a diagnosis of CRPS I and CRPS II (peripheral causalgia). In Europe and Australia, DRG stimulation is indicated for treatment of patients with chronic, intractable pain. ĭRG stimulation was approved for use in Europe in 2011 and Australia in 2012. In addition to significant improvements in pain and quality of life, the ACCURATE study DRG cohort also reported significantly less paresthesia, minimal postural variation, and reduced paresthesia outside of the targeted painful area as compared with the control group (dorsal column spinal cord stimulation). In the ACCURATE study, a diagnosis of peripheral causalgia or CRPS type II was made in accordance with accepted diagnostic criteria, that is, pain resulting from known damage to a “named” nerve (i.e., saphenous nerve, ilioingional nerve, etc.) “in an anatomical area consistent with the innervation pattern of the damaged nerve (or nerves), and generally, in a hyperalgesic state”. published the results of the ACCURATE study (a prospective, multicenter randomized clinical trial) that showed dorsal root ganglion (DRG) stimulation to be superior to conventional dorsal column stimulation for the treatment of complex regional syndrome (CRPS) type I (reflex sympathetic dystrophy ) and type II (causalgia). Fortunately, a new and innovative neuromodulation therapy is available that allows stimulation to be focused on specific painful areas/regions of the body, thus addressing one of the limitations of dorsal column spinal cord stimulation (SCS) in conditions like NPP. Stimulation of the dorsal columns, while effective for treating broad, nonspecific regions of pain, has had well-documented shortcomings in treating focal neuropathic pain-the hallmark of neuropathic postsurgical pain (NPP). Chronic postsurgical pain is an important cause of morbidity that is often neuropathic in nature and has historically been difficult to treat.
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