Understanding DRG Stimulation: A Targeted Approach for Neuropathic Pain

Chronic neuropathic pain can be one of the most difficult conditions to treat effectively. Often resistant to traditional therapies such as medications, physical therapy, or even standard spinal cord stimulation (SCS), patients with localized nerve pain need a more focused solution. That’s where Dorsal Root Ganglion (DRG) stimulation offers hope—a cutting-edge, targeted therapy designed specifically for focal neuropathic pain.

In this post, we’ll explore what DRG stimulation is, how it works, who it helps, and what patients can expect from the procedure.

What Is DRG Stimulation?

DRG stimulation is a form of neuromodulation therapy that targets the dorsal root ganglia—nerve cell clusters located along the spine that transmit sensory information from specific parts of the body to the central nervous system.

Unlike traditional spinal cord stimulation, which spreads electrical impulses over a broad area, DRG stimulation is more focused. It allows physicians to direct stimulation to very specific dermatomes—areas of the skin supplied by a single spinal nerve. This makes DRG therapy especially helpful for patients suffering from localized neuropathic pain, such as:

• Complex Regional Pain Syndrome (CRPS)
• Post-surgical neuropathic pain
• Groin pain after hernia repair
• Foot and ankle pain
• Pelvic pain
• Post-amputation phantom limb pain

How Does DRG Stimulation Work?

The DRG contains sensory neurons that carry pain signals to the spinal cord and brain. DRG stimulation uses a small implanted device to send mild electrical pulses to these neurons, interrupting or modulating pain signals before they reach the brain.

The system typically includes:

1. Leads (electrodes): Placed near the targeted DRG.
2. Pulse generator: A small implanted device (similar to a pacemaker) that delivers electrical stimulation.
3. External controller: Used by the patient to adjust settings and control stimulation levels.

Because the DRG is encased in a rigid bony structure, the placement of leads is highly stable. This allows for precise targeting and consistent pain relief, even when patients move, bend, or shift positions—something not always achievable with standard SCS systems.

Conditions That May Benefit from DRG Therapy

DRG stimulation is FDA-approved for treating Complex Regional Pain Syndrome (CRPS) I and II in the lower limbs. However, its use is expanding into other forms of chronic, localized neuropathic pain, including:

• Peripheral nerve injuries
• Post-surgical inguinal or groin pain
• Knee pain following total knee replacement
• Foot pain post-ankle surgery
• Pelvic pain or pudendal neuralgia
• Phantom limb pain

Benefits of DRG Stimulation

Patients who qualify for DRG therapy often experience a high level of targeted pain relief, with a number of additional benefits:

• Precise coverage of hard-to-reach areas (like the groin or foot)
• Stable relief regardless of body position
• Lower stimulation intensity needed for effect
• Reduced side effects compared to traditional spinal cord stimulation
• Minimally invasive implantation procedure
• Improved function, mood, and sleep due to reduced pain

Several clinical studies, including the ACCURATE trial, have demonstrated that DRG stimulation provides superior pain relief over conventional SCS in select patients, particularly those with CRPS.

The Evaluation and Trial Process

Not everyone is a candidate for DRG stimulation, and the process typically starts with a pain specialist or neurosurgeon evaluation. If a patient meets the criteria, they will usually undergo a trial stimulation to test the effectiveness of DRG therapy before committing to a permanent implant.

Here’s what the process looks like:

1. Initial consultation: Medical history review, imaging, and physical exam.
2. Trial phase: Temporary leads are placed and connected to an external stimulator for 5–7 days.
3. Evaluation: If pain is reduced by at least 50%, the patient may qualify for a permanent implant.
4. Implantation: A minor outpatient procedure is done to implant the leads and pulse generator.
5. Programming: The stimulator is adjusted to optimize pain relief over time.

Risks and Considerations

As with any medical procedure, there are risks involved, although DRG stimulation is generally safe. Some potential complications include:

• Lead migration
• Infection at the surgical site
• Pain at the implant site
• Hardware malfunction
• Unwanted changes in stimulation

However, these risks are relatively rare and can often be corrected. Many patients feel the benefits outweigh the risks, especially when other treatments have failed.

Life After DRG Stimulation

After successful implantation, most patients are able to resume normal activities with fewer limitations. The ability to manage pain without relying heavily on opioids or other medications can be life-changing.

With follow-up care and proper programming, patients often report:

• Decreased daily pain
• Better sleep
• Improved mobility and activity levels
• Enhanced emotional wellbeing

Is DRG Stimulation Right for You?

If you suffer from chronic, localized neuropathic pain that hasn’t responded to conventional treatments, DRG stimulation may be a viable option. It’s especially effective for conditions involving the groin, foot, knee, or lower limb pain due to nerve injury or CRPS.

A thorough evaluation by a specialist can determine whether this targeted therapy could help restore comfort, mobility, and quality of life.