A Breakthrough Therapy for Chronic Pain

Ask the Experts

PalmieriMarco Palmieri, DO
Director, Center for Pain Management              Division Chief, Chronic Pain

Patients are finding new hope for relief of chronic, nerve-related pain with Dorsal Root Ganglion (DRG) therapy, a newer, FDA-approved treatment. Stony Brook Medicine pain expert Marco Palmieri, DO, trained in this therapy, explains how it works and who may benefit from it.

What is Dorsal Root Ganglion (DRG) therapy?
Dorsal Root Ganglion (DRG) therapy is a newer type of pain treatment, which has been shown to help patients with lower-body chronic nerve pain conditions who have not be able to get relief with other, more conservative treatments. 
However, because this treatment is new and can be technically challenging, few physicians are trained to perform it. Right now there are only two doctors in Suffolk County who perform DRG therapy.

How does DRG therapy work?
DRG is similar to traditional spinal cord stimulation in that there are leads and a battery device. Leads are placed over the dorsal root ganglion, a nerve structure which acts almost like a traffic light regulating signals as they travel to the spinal cord and brain. 
The leads are implanted through a needle, while a battery is usually implanted in the flank area. The leads are driven, or steered, toward the targeted DRG that is linked to the patient’s pain.

Who is DRG therapy for?
DRG therapy is indicated for patients with chronic nerve pain due to Complex Regional Pain Syndrome (CRPS). What’s exciting about this therapy is that now we’re able to better target pain syndromes that were often difficult to treat with conventional spinal cord stimulation. DRG therapy can be used to treat certain nerves in the lower body that sustain an injury and cause chronic pain. This can include lower back pain, post-hernia pain, and leg pain, to name a few. 
Typically DRG therapy is reserved for patients who have failed with other therapies. There are more conservative approaches to managing patients’ pain that we exhaust beforehand. If they haven’t worked, DRG therapy may be an option.

What is the age range of patients who can receive DRG therapy?
DRG therapy, like conventional spinal cord stimulation, can be used in patients of almost any age. I’ve placed spinal cord simulation devices in patients from ages 16 up to age 90. 

What does the procedure involve?
We begin with a trial period, a “test drive,” which allows the patient to feel what the treatment is like before committing to having a permanent implant. 
We temporarily place the leads with a needle, but with no incision. Patients then undergo a five- to seven-day trial to see if they achieve definable goals, which we set before the trial. Some of these goals may be things like 50 percent pain reduction, reduced medication usage or the ability to perform a particular activity for a longer period of time.

What happens after the trial period?
If a patient has a successful trial, he or she can move onto the permanent implant, which is when the leads and battery are placed permanently into the body. 
The trial procedure typically takes 45 minutes to an hour; the permanent implantation takes a bit longer. Neither procedure is usually performed under general anesthesia; instead, we use a local anaesthetic and sedation. It’s usually done at an ambulatory surgery center so the patient can go home that day. After the procedure, we generally ask patients to be on minimally modified activity for about four to six weeks; particularly avoiding extreme bending or twisting.

What else makes DRG an attractive option?
DRG is what’s called a paresthesia-free system. With most traditional spinal cord stimulation systems, there is a constant tingling or vibration that some patients don’t like. Also, DRG stimulation is more focused, meaning that we can just target the painful nerve instead of stimulating additional non-painful areas. Patients don’t usually feel it working per se. They just know that they feel better.

To be evaluated at the Center for Pain Management, patients must be referred by their primary physician or specialist. Contact us at (631) 638-0800 with any questions or concerns. Our professional staff is available from 8:30 am to 5 pm, Monday through Friday. For more information, visit the website at stonybrookmedicine.edu/patientcare/chronicpain

For more information about Stony Brook Medicine, call (631) 444-4000.

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