scholarly journals First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China

2017 ◽  
Vol 3 (20;3) ◽  
pp. E411-E418 ◽  
Author(s):  
EungDon Kim
Keyword(s):  
Herpes Zoster ◽  
Dorsal Root Ganglion ◽  
Postherpetic Neuralgia ◽  
Medical Records ◽  
Dorsal Root ◽  
Rating Scale ◽  
Small Sample ◽  
Intractable Pain ◽  
Clinical Effects ◽  
Pulsed Radiofrequency

Background: Latent varicella zoster virus reactivates mainly in sensory ganglia such as the dorsal root ganglion (DRG) or trigeminal ganglion. The DRG contains many receptor channels and is an important region for pain signal transduction. Sustained abnormal electrical activity to the spinal cord via the DRG in acute herpes zoster can result in neuropathic conditions such as postherpetic neuralgia (PHN). Although the efficacy of pulsed radiofrequency (PRF) application to the DRG in various pain conditions has been previously reported, the application of PRF to the DRG in patients with herpes zoster has not yet been studied. Objectives: The aim of the present study was to compare the clinical effects of PRF to the DRG in patients with herpes zoster to those of PRF to the DRG in patients with PHN. Study Design: Retrospective comparative study. Setting: University hospital pain center in Korea. Methods: The medical records of 58 patients who underwent PRF to the DRG due to zoster related pain (herpes zoster or PHN) were retrospectively analyzed. Patients were divided into 2 groups according to the timing of PRF after zoster onset: an early PRF group (within 90 days) and a PHN PRF group (more than 90 days). The efficacy of PRF was assessed by a numeric rating scale (NRS) and by recording patient medication doses before PRF and at one week, 4 weeks, 8 weeks, and 12 weeks after PRF. Results: Pain intensity was decreased after PRF in all participants. However, the degree of pain reduction was significantly higher in the early PRF group. Moreover, more patients discontinued their medication in the early PRF group, and the PRF success rate was also higher in the early PRF group. Limitations: The relatively small sample size from a single center, short duration of review of medical records, and the retrospective nature of the study. Conclusions: PRF to the DRG is a useful treatment for treatment-resistant cases of herpes zoster and PHN. Particularly in herpes zoster patients with intractable pain, application of PRF to the DRG should be considered for pain control and prevention of PHN. Key words: Pulsed radiofrequency, dorsal root ganglion, herpes zoster, postherpetic neuralgia

scholarly journals Pulsed Radiofrequency Application at Some Dorsal Root Ganglions Could Cause Drastic Neuromodulation throughout the Whole Body

2017 ◽  
pp. 223-229
Author(s):  
Young-Chang Arai
Keyword(s):  
Dorsal Root Ganglion ◽  
Analgesic Effect ◽  
Dorsal Root ◽  
Nervous Tissue ◽  
Case Series ◽  
Nerve Fibers ◽  
Whole Body ◽  
Intractable Pain ◽  
Pulsed Radiofrequency ◽  
Modified Technique

Background: The modified technique, pulsed radiofrequency (PRF) procedure, applied to nervous tissue has been providing anecdotal benefits for the management of chronic and intractable pain conditions. Although PRF has a neuromodulatory effect instead of thermally lesioning nervous tissue, the mechanism underlying the analgesic effect of PRF has not been fully clarified yet. Objectives: To see the changes of electricallyevoked responses of peripheral A-δ and A-β nerve fibers and the analgesic effect induced by PRF. Study Design: Case series. Setting: Inpatient. Methods: This study investigated how dorsal root ganglion (DRG) PRF influenced electricallyevoked responses of peripheral A-δ and A-β nerve fibers at the treated root ganglion dominating areas in five patients with intractable vertebral metastatic pain. Results: DRG PRF provided sound pain relief for patients with intractable vertebral metastatic pain. PRF application at DRGs had a different effect on electrically-evoked responses of peripheral A-δ and A-β nerve fibers at not only the treated root ganglion dominating areas but also the nontreated root ganglion dominating areas far from the treated root ganglion dominating areas in each patient. Limitation: This report is a case series. Conclusions: PRF application at some peripheral nerves could cause drastic neuromodulation throughout the whole body. Key words: Pulsed radiofrequency, dorsal root ganglion block, neuromodulation

scholarly journals Two Cases of Dorsal Root Ganglion Stimulation for the Treatment of Postherpetic Neuralgia

2020 ◽  
pp. 179-182
Author(s):  
Chong Kim
Keyword(s):  
Spinal Cord ◽  
Dorsal Root Ganglion ◽  
Postherpetic Neuralgia ◽  
Spinal Cord Stimulation ◽  
Dorsal Root ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Intractable Pain ◽  
Thoracic Level ◽  
Significant Burden

Background: Postherpetic neuralgia (PHN) is the most common long-term complication of shingles and is a significant burden to the patients due to pain and disability. Currently, treatment options are limited. In refractory cases, neuromodulation using spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS) have been used but is considered experimental due to limited evidence. Dorsal root ganglion (DRG) stimulation has been most studied in complex regional pain syndrome and uses electrical leads that are inserted into the epidural space and placed into the intervertebral foramen to target the DRG. Due to the advantages on targeting the DRG, DRG stimulation has been used and can be considered to treat other refractory, intractable pain conditions. Case Report: We report 2 cases who experienced successful treatment of refractory PHN. Patients underwent dorsal root ganglion stimulation at the thoracic level for the treatment of refractory PHN. Both patients showed significant improvement in pain at 24 and 36 months after a DRG stimulation trial and implantation. Conclusion: We report the successful use of DRG stimulation for the treatment of PHN. Key words: Dorsal root ganglion stimulation, neuralgia, neuromodulation, postherpetic neuralgia, spinal cord stimulation

scholarly journals Pulsed radiofrequency of dorsal root ganglion of upper thoracic segment for herpes zoster neuralgia

Medicine ◽  
2020 ◽  
Vol 99 (25) ◽  
pp. e20807
Author(s):  
Yong Fei ◽  
Jiajia Deng ◽  
Hui Lv ◽  
Ming Yao ◽  
Tingting Wang ◽  
...  
Keyword(s):  
Herpes Zoster ◽  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Thoracic Segment ◽  
Pulsed Radiofrequency ◽  
Upper Thoracic

scholarly journals Effectiveness of “Transgrade” Epidural Technique for Dorsal Root Ganglion Stimulation. A Retrospective, Single-Center, Case Series for Chronic Focal Neuropathic Pain

2019 ◽  
Vol 6 (22;6) ◽  
pp. 601-611
Author(s):  
Adnan Al-Kaisy
Keyword(s):  
Neuropathic Pain ◽  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Rating Scale ◽  
Small Sample Size ◽  
Case Series ◽  
Implantation Rate ◽  
Pain Syndrome ◽  
Small Sample ◽  
Electrode Placement

Background: The recent interest in targeting the dorsal root ganglion (DRG) has led to the development of new techniques of electrode placement. In this article, we describe a new “Transgrade” approach to the DRG, accessing the contralateral interlaminar space and steering the lead out the opposite foramen. Objectives: The purpose of this study was to evaluate the Transgrade technique to the DRG in the management of focal neuropathic pain, predominately complex regional pain syndrome in terms of efficacy and safety. Study Design: A retrospective, observational review of all patients selected for DRG stimulation using the Transgrade technique to the DRG. Setting: Pain Management and Neuromodulation Centre, Guys and St. Thomas NHS Foundation Trust, London, United Kingdom. Methods: Data were taken from a hospital password-protected database. All patients were contacted by telephone for Numeric Rating Scale (NRS-11) score, Patient Global Impression of Change (PGIC) score, and complications. A patient responder was defined as having a PGIC score of 6 or 7, and a 2-point reduction from baseline NRS-11. Results: A total of 39 patients (46% women) with a mean age of 46 years (± 2) underwent a trial of DRG stimulation that resulted in an implantation rate of 82% (32 of 39). The responder rates, according to NRS-11 and PGIC results, were 87% (28 of 32) at 6 weeks and 66% (21 of 32) at a mean of 18 months (± 1.8) follow-up. Pocket pain was the most common complication, occurring in 7 of 32 (22%) patients, and the lead migration rate was 3 out of 57 leads placed (5.2%). A burst protocol was the favored method of stimulation in the majority of patients, 25 of 32 (78%). Limitations: Retrospective nature of design, small sample size. Conclusions: The Transgrade technique of placing DRG leads offers an alternative method that is safe and effective. New methods of stimulation to the DRG offer more choice and potentially better efficacy for patients with chronic neuropathic pain.

scholarly journals Effectiveness of Pulsed Radiofrequency with Multifunctional Epidural Electrode in Chronic Lumbosacral Radicular Pain with Neuropathic Features

2014 ◽  
Vol 6;17 (6;12) ◽  
pp. 477-486 ◽  
Author(s):  
Simone Vigneri
Keyword(s):  
Neuropathic Pain ◽  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Rating Scale ◽  
Radicular Pain ◽  
Pain Intensity Score ◽  
Pulsed Radiofrequency ◽  
Number Of Patients ◽  
Pre Treatment

Background: Lumbosacral radicular pain is a common clinical finding with a statistical prevalence ranging from 9.9% to 25% in the general population. Objective: To investigate the effectiveness of dorsal root ganglion pulsed radiofrequency (PRF) in patients with chronic lumbosacral radicular pain and neuropathic features. Study Design: Prospective case series clinical outcome study. Methods: We evaluated 34 patients with lumbosacral neuropathic pain who underwent PRF at the corresponding level of radicular symptoms distribution (ranging from L3 to S1). Each patient suffered a single leg-radiating pain with probable neuropathic features (assessed with clinical grading) lasting for > 6 months and unresponsive to previous treatments. A multifunctional PASHA-electrode® was introduced with trans-sacral access through a hollow needle, placed under fluoroscopic guidance into the lumbosacral epidural space and its active tip moved close to the dorsal root ganglion responsible of the clinical symptoms. After connecting the electrode to a generator, stimulation tests were performed and PRF was started and applied for 240 seconds at a frequency of 2Hz, amplitude of 45 V and a tip temperature between 40 – 42°C. If the pain involved more than a single nerve root, the electrode was placed at a different segment and the procedure repeated. Outcome measures included the pain intensity score on a 0 – 10 numeric rating scale (NRS) and the Italian Pain Questionnaire (QUID) at pre-treatment, one and 6 months post-treatment. P values < 0.05 were considered statistically significant. Results: In comparison with pre-treatment, a significant reduction in pain score was observed in mean NRS either at one and 6 months (P < 0.001). The QUID - Pain Rating Index rank displayed a parallel trend at the first (P < 0.001) and last follow-up (P = 0.01). Moreover, a direct correlation between the 2 scales occurred, showing a parallel score decreasing (P < 0.001). Eighteen (52.9%) and 17 (50%) of 34 patients showed pain reduction in NRS > 2 points and > 30%, at one and 6 months, respectively. Limitations: The non-controlled design of the study, the patients were heterogeneous, the small number of patients, and the duration of follow-up was limited to 6 months. Conclusions: PRF of dorsal root ganglion performed with a multifunctional electrode for > 240 seconds appears to be safe and might be more effective than the classic 120 seconds needlemediated approach. Therefore, it may be considered as a valuable tool for the treatment of lumbosacral radicular pain with neuropathic features. Key words: PRF, radicular pain, neuropathic pain, DRG, NRS, PRIr-T, multifunctional electrode

scholarly journals Pulsed Radiofrequency Dorsal Root Ganglion-Fluoroscopy Guide for Lumbar Radicular Pain

2021 ◽  
Vol 2 (2) ◽  
pp. 82-88
Author(s):  
Nugroho Wicaksono ◽  
Keyword(s):  
Neuropathic Pain ◽  
Dorsal Root Ganglion ◽  
Dorsal Root ◽  
Rating Scale ◽  
Positive Outcome ◽  
Radicular Pain ◽  
Pulsed Radiofrequency ◽  
Post Intervention ◽  
Disc Protrusion ◽  
Lumbar Radicular Pain

Background: Lumbosacral radicular pain is the most common neuropathic pain. Pulsed Radio Frequency (PRF) is a method that believes to be safe and effective for reducing pain. Case: A 43-year-old woman experiences chronic right lumbar radiculopathy due to Herniated nucleus pulposus (HNP) L4-5. Anamnesis and physical examination show a sign of neuropathic pain. The MRI examination shows a paracentral disc protrusion L4-5 that compresses the transversing nerve L5. The conservative management did not produce a satisfying result indicated by the patient still experience pain with the Numeric Rating Scale (NRS) 4-5. Patient unable to do activity properly. We perform pain management using the dorsal root ganglion L5 pulsed radiofrequency-fluoroscopy (PRF) and producing a positive outcome. Patients experience a decrease in pain intensity with NRS 1. The examination on one and two months post-intervention show an improvement. Patient able to do the daily activity with NRS 1-2. Conclusion: Pulsed radiofrequency dorsal root ganglion-fluoroscopy guide that relatively safe, minimum complications, and minimal side effects, making it the preferred treatment for chronic lumbar radicular pain.

scholarly journals Dorsal Root Ganglion Pulsed Radiofrequency Treatment for Chronic Radicular Pain: A Narrative Mini Review

2021 ◽  
Vol 9 (4) ◽  
Author(s):  
Alberto Negro ◽  
Vincenzo Agostino ◽  
Luigi Gatta ◽  
Francesco Somma ◽  
Fabio Tortora
Keyword(s):  
Dorsal Root Ganglion ◽  
Radio Frequency ◽  
Dorsal Root ◽  
Biological Effects ◽  
Radicular Pain ◽  
Sufficient Evidence ◽  
Clinical Effects ◽  
Pulsed Radiofrequency ◽  
Pulsed Radiofrequency Treatment ◽  
The Individual

Chronic cervical and lumbar radicular pain represents a very widespread neuropathic pain in the population with serious repercussions on the individual and social health. To date, we do not have sufficient evidence available to allow us to make recommendations on the optimal therapy, despite the fact that various ways of treating root pain have been described over the years. Currently, conservative treatment of radicular pain relies on combined therapeutic, pharmacological and physiotherapeutic management. Interventional therapeutic procedures are reserved for those patients with root pain refractory to conservative therapies. Radio frequency (RF) can provide a good treatment option with Pulsed Radio frequency (PRF) modality. We evaluate clinical and radiologic effects of the therapeutic outcome of pulsed radiofrequency (PRF) treatment adjacent to the dorsal root ganglion (DRG) for patients with chronic intractable lumbar and cervical radicular pain in this narrative minireview, describing mechanism of action, biological effects and evidence for clinical effects and safety in recently published studies.

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