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Published on: February 10, 2011
Comparative Effectiveness of Dorsal Root Ganglion and Spinal Cord Stimulation in Chemotherapy-Induced Peripheral
Gregory Blazek1, Noushad Mamun2, Saba Javed2
1Department of Physical Medicine and Rehabilitation, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA.
Objectives:
Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating consequence of many necessary oncologic treatments. Spinal cord stimulation (SCS) is the more common option for refractory cases, but growing evidence suggests dorsal root ganglion stimulation (DRG-S) is another viable option. This study aims to retrospectively compare the use of DRG-S and SCS to determine the modality chosen for permanent implantation for treatment of lower extremity CIPN.
Materials And Methods:
This is a retrospective, single-center case series in which five patients with lower extremity CIPN underwent a trial with percutaneous lead placement with an external pulse generator for both modalities. DRG-S was trialed first for five days, followed by a wash-out period of one day; next, SCS was trialed for two to five days. Treatment-induced neuropathy assessment scale (TNAS) scores were collected for each patient.
Results:
A total of five patients with CIPN affecting the lower extremities met the inclusion criteria for this retrospective analysis. All patients presented with bilateral foot pain, with one patient also reporting concomitant lower back pain. The mean duration of CIPN symptoms in this cohort was approximately four years. Mean baseline TNAS score was 56.8, decreasing to 35.8 after the DRG-S trial and to 40.4 after the SCS trial.
Conclusion:
Our retrospective case series expands on the growing body of evidence supporting neuromodulation therapies for treatment-refractory chronic CIPN. Specifically, DRG-S indicates a well-tolerated treatment modality with positive clinical outcomes in alleviating isolated CIPN-related pain. Analysis also suggests the need for further research to identify optimal patient selection when considering DRG-S or conventional SCS to treat CIPN.
