Dorsal Root Ganglion Stimulation for Thoracic Neuralgia: A Report of Six Cases.

• Type of Material: Article
• Authors: Casey L. Anthony, Emory University; Muhibullah S. Tora, Emory University; Jessica N. Bentley, University of Alabama Birmingham; Pavlos Texakalidis, Emory University; Nicholas Boulis, Emory University
• Language: English
• Date: 2019-05-07
• Publisher: Cureus, Inc.
• Publication Version: Final Published Version
• Copyright Statement: © 2019, Anthony et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.7759/cureus.4615
• Title of Journal or Parent Work: Cureus
• ISSN: 2168-8184
• Volume: 11
• Issue: 5
• Start Page: e4615
• End Page: e4615
• Keywords: thoracic neuralgia; stimulation; dorsal root ganglion; pain; neuropathic pain; thorax; thoracic
• Research Categories: Biology, Neuroscience; Health Sciences, Medicine and Surgery

Abstract

OBJECTIVE: Thoracic neuralgia (TN) is a chronic pain syndrome that can be refractory to pharmacologic intervention and management by pain specialists. Dorsal root ganglion (DRG) stimulation has shown promise as a targeted and effective modality compared to traditional therapies for several indications but has not yet been applied in the thoracic region. This study aims to report the outcomes of off-label thoracic DRG stimulation in patients with refractory TN. METHODS: A retrospective chart review was performed at Emory University Hospital for patients who underwent thoracic DRG stimulation in a two-year period. Relevant outcomes for safety and efficacy were evaluated. RESULTS: Six patients were identified that underwent thoracic DRG stimulation for various etiologies of TN, including post-mastectomy, post-herpetic, and post-abdominoplasty neuralgia. All patients initially underwent trial DRG stimulation with a mean pre-operative visual analogue scale (VAS) (0-10) of 6.8 ± 1.6 (range: 4-8). Four of six patients (67%) were non-responders and did not pursue permanent implantation; two experienced pain with stimulation during the trial, and two patients experienced no significant benefit. In addition, all three patients with post-herpetic neuralgia did not respond to treatment. Two of six patients (33%) responded well to stimulation, elected to receive permanent leads, and reported significant pain relief with VAS scores of 0/10 and 1/10, and 100% reduction in morphine equivalent use. Complications included lead migration and need to reset stimulator programming. CONCLUSIONS: DRG stimulation may be an effective therapy for patients experiencing chronic TN as a result of peripheral nerve injury; however, post-herpetic neuralgia may be unresponsive to this treatment. Future prospective studies are warranted to evaluate the feasibility of this procedure in patients with refractory TN.