Spinal cord stimulation is often used as a last resort. To start with, that is a mistake.
Dr. K Kumar pioneered efforts to use spinal stimulation:
Here is a list of some of his articles:
I have been practicing long enough in his town to hear him speak and one thing always stuck with me. He bemoaned how long it took for subjects to get to him for treatment as he felt early intervention improved results. Some years ago at a conference, spinal stimulation was discussed but the neurosurgeon was unaware of Dr. Kumar’s 22+ years of experience culminating in that revelation. I was shocked.
So, subjects are seen late, and fail to achieve adequate relief with spinal stimulation even with new modes being used- then what do you do? I try IV pamidronate, ketamine and even methadone might have a place. Now, it looks like adding a stimulator more externally to the outlet of the spinal cord where the dorsal root ganglion is, could make the difference.
From a Canadian Site that offers this approach:
“DRG procedure is considered a minor surgical procedure, which is usually low risk and major complications are rare. DRG treatment is reversible and the devices can be removed if necessary.”
Doesn’t sound like arduous – what is, is getting done in the present state of our healthcare..
Ghosh P, Gungor S.
Utilization of Concurrent Dorsal Root Ganglion Stimulation and Dorsal Column Spinal Cord Stimulation in Complex Regional Pain Syndrome.
Neuromodulation. 2021 Jun;24(4):769-773.
4 cases lower extremity type 1 CRPS
Don’t get access to that journal so best I can do is quote:
“All four patients reported further improvement in their residual pain and function with DRG-S [dorsal root ganglion stimulation (>60%), and even superior pain relief (>80%) with concurrent use of t-SCS .”
Comment – have a patient with CRPS following injury, was late to have stimulator and has inadequate control despite new waveforms used. Coverage is not adequate. This is an arm case so not sure is relevant but still would hope drg stim would help.