Rev. Soc. Esp. Dolor. 2021; 28(2): 148-156 / DOI: 10.20986/resed.2021.3879/2020
Miguel Ángel Caramés, Ignacio Javier Jorge, Minerva Navarro, Rafael Omaña, María Prats, Francisco Cabrera, David Suárez, Bernardino Clavo
ABSTRACT
Background: The Dorsal Root Ganglion Stimulation is a part from the treatment of the refractory neuropathic pain to a medical treatment, interventionism or central neurostimulation which have not work.
Methods: This observational, prospective study show the results of 10 patients who has been implanted a Dorsal Root Ganglion Stimulation (DRGS) system following the clinical practice. All the patients suffer from refractory neuropathic pain to a medical and interventionism treatment. Eight of these patients passed the test phase due to an improvement of 50 %, 5 cases were patients who suffer from a traumatic or postsurgical peripheral nerve injury. The main objectives of the study were the assessment of changes in pain intensity, functionality and levels of anxiety and depression. The follow-up time was 6 months after the implantation of the generator.
Results: Eight patients passed the test phase when a decrease in pain intensity was found to be greater than 50 %, 5 of these suffered pains secondary to traumatic or postsurgical peripheral nerve injury, the other three fallisuffered neuropathic pains of other origins. We found a 63 % decrease in pain intensity in the VAS, a 70 % subjective general improvement, a clear decrease in analgesia, a functional improvement on the Oswestry scale, and an improvement in anxiety and depression levels (HAD scale). The best results were obtained in patients with electrode implanted at L5 root for the treatment of pain in the foot or ankle and allodynia. We found an absence of changes in stimulation in relation to posture and an area of stimulation similar with the area of pain. The complications were few and not severe.
Conclusion: To conclude, this technique is an effective, safe and it will probably have a great future in the field of neurostimulation for refractory neuropathic pain.
RESUMEN
Introducción: La estimulación del ganglio de la raíz dorsal forma parte del manejo terapéutico del dolor neuropático refractario en aquellos casos donde el tratamiento médico, intervencionista o la estimulación central no han podido dar solución al mismo.
Metodología: Se presentan los resultados de un estudio observacional, prospectivo, en 10 pacientes a los que les ha sido implantado el sistema de estimulación del ganglio de la raíz dorsal (EGRD), según la práctica clínica habitual, para el alivio de dolores neuropáticos refractarios al tratamiento médico e intervencionista. Los objetivos principales del estudio fueron la valoración en los cambios de la intensidad del dolor, en la funcionalidad y en los niveles de ansiedad y depresión. El tiempo de seguimiento fue de 6 meses tras el implante del generador.
Resultados: 8 pacientes superaron la fase de prueba al constatarse una disminución de la intensidad del dolor superior al 50 %: 5 de estos sufrían dolores secundarios a lesión nerviosa periférica traumática o postquirúrgica, los otros 3 padecían dolores neuropáticos de otros orígenes. Se constató una disminución de la intensidad del dolor del 63 % en la EVA, mejoría general subjetiva del 70 %, disminución de la toma de analgésicos, mejoría funcional en la escala Oswestry, así como en los niveles de ansiedad y depresión (Escala HAD). Los mejores resultados se obtuvieron en los pacientes en los que se les implantó un electrodo en el ganglio de la raíz dorsal L5 para el tratamiento de dolores en miembros inferiores y con sensación de alodinia. No se objetivaron cambios en la estimulación en relación con la postura y sí gran concordancia entre el área de parestesia y del dolor. Las complicaciones fueron escasas y en ningún caso graves.
Conclusión: Se trata de una técnica eficaz, segura y que probablemente tendrá un gran futuro dentro del campo de la neuroestimulación para los dolores neuropáticos refractarios.
Nuevo comentario
Comentarios
No comments in this article
Bibliografía
1. Treede RD, Jensen TS, Campbell JN, Cruccu J, Dostrovsky JO, Griffin JW, et al. Neuropathic pain. Redefnition and a grading system for clinical and research purposes. Neurology. 2008;70(18):1630-35.
2. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: Prevalence, impacto on daily life and treatment. Eur J Pain. 2006;10(4):287-333.
3. Van Hecke O, Austin SK, Khan RA, Smith BH, Torrance N. Neuropathic pain in the general population. A systematic review of epidemiological Studies. Pain. 2014;155(4):654-62.
4. Bouhassira D, Lantéri-Minet M, Attal N, Laurent B, Touboul C. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain. 2008;136(3):380-7.
5. Krames ES. The dorsal root ganglion in chronic pain and as a target for neuromodulation: a review. Neuromodulation. 2015;18(1):24-32.
6. Harrison C, Epton S, Bojanic S, Green AL, FitzGerald JJ. The Efficacy and Safety of Dorsal Root Ganglion Stimulation as a Treatment for Neuropathic Pain: A Literature Review. Neuromodulation. 2018;21(3):225-33.
7. Deer T, Levy RM, Kramer JM. Interventional Perspectives on the Dorsal Root Ganglion as a Target for the Treatment of Chronic Pain: a Review. En: Minimally invasive surgery for pain. Vol 2. Boutherm academic press; 2014. p. 23-33.
8. Vancamp T, Levy RM, Peña I, Pajuelo A. Relevant Anatomy, Morphology, and Implantation Techniques of the Dorsal Root Ganglia at the Lumbar Levels. Neuromodulation 2017;20(7):690-702.
9. Flórez García MT, García Pérez MA, García Pérez F, Armenteros Pedreros J, Álvarez Prado A, Martínez Lorente MD. Adaptación transcultural a la población española de la escala de incapacidad por dolor lumbar de Oswestry. Rehabilitación (Madr). 1995;29:138-45.
10. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361-70.
11. Huygen FJPM, Kalleward JW, Nijhuis H, Liem L, Vesper J, Fahey ME, et al. Effectiviness and Safety of Dorsal Root Ganglion Stimulation for the Treatment of Chronic Pain: A Pooled Analysis. Neuromodulation. 2020;23(2):213-21.
12. Deer TR, Levy RM, Kramer J, Poree K, Amirdelfan K, Grigsby E, et al. 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. Pain. 2017;158(4):669-81.
13. Liem L, Russo M, Huygen FJ, Van Buyten JP, Smet I, Verrills P, et al. One-year outcomes of spinal cord stimulation of the dorsal root ganglion in the treatment of chronic neuropathic pain. Neuromodulation. 2015;8(1):41-8.
14. Van Buyten JP, Smet I, Liem L, Russo M, Huygen F. Stimulation of dorsal root ganglia for the management of complex regional pain syndrome: a prospective case series. Pain Pract. 2015;15(3):208-16.
15. Schu S, Gulve A, ElDabe S, Baranidharan G, Wolf K, Demmel W, et al. Spinal cord stimulation of the dorsal root ganglion for groin pain-a retrospective review. Pain Pract. 2015;15(4):293-9.
16. Morgalla MH, Bolat A, Fortunato M, Lepski G, Chander BS. Dorsal root ganglion stimulation used for the treatment of chronic neuropathic pain in the groin: A single-center study with long-term prospective results in 34 cases. Neuromodulation. 2017;20(8):753-60.
17. Morgalla MH, Fortunato M, Lepski G, Chander BS. Dorsal root ganglion stimulation (DRGS) for the treatment of chronic neuropathic pain: A single-center study with long-term prospective results in 62 cases. Pain Physician 2018;21(4):E377-87.
18. Huygen F, Liem L, Nijhuis H, Cusack W, Kramer J. Evaluating dorsal root ganglion stimulation in a prospective Dutch cohort. Neuromodulation. 2019;22(1):80-6.
19. Kallewaard JW, Edelbroek C, Terheggen M, Raza A, Geurts JW. A prospective study of dorsal root ganglion stimulation for non-operated discogenic low back pain. Neuromodulation. 2020;23(2):196-202.
20. Kallewaard JW, Nijhuis H, Huygen F, Wille F, Zuidema X, van de Minkelis J, et al. Prospective cohort analysis of DRG stimulation for failed Back surgery syndrome pain following lumbar discectomy. Pain Pract 2019;19(2):204-10.
21. Smits H, Ultenius C, Deumens R, Koopmans GC, Honig WM, van Kleef M, et al. Effect of spinal cord stimulation in an animal model of neuropathic pain relates to degree of tactile "allodynia". Neuroscience 2006;143(2):541-6.