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DRG Stimulators

A DIFFERENT TYPE OF PAIN CALLS FOR A DIFFERENT APPROACH.

Chronic pain is a common condition, affecting almost one in five adults globally. But yours is different from most. You’ve tried the methods that work for other people, but nothing seems to help. It’s well known that this kind of pain is limited to a specific area of your body. This sort of difficult-to-treat isolated chronic pain may start in a lower extremity (foot, knee, hip, and groin) following an injury or surgical procedure and grow worse over time.

Now imagine your life transformed. Because today, there’s a unique approach to pain like yours: neurostimulation that stimulates the dorsal root ganglion—a cluster of nerve cells in the spine, also called the DRG—that directly targets the area of the body where your pain occurs. This is a new therapy using a well-studied and understood approach for addressing the type of pain you’re suffering. DRG therapy is the next generation in pain relief and it’s offered exclusively by St. Jude Medical.

HERE’S HOW DRG THERAPY CAN HELP.

The Dorsal Root Ganglion (DRG) has been of interest to pain physicians for years. This nerve cluster acts like a traffic light, regulating signals and sensations as they travel to the brain. Stimulation of the DRG can actually modify the pain signals getting through—resulting in the reduction of pain.

For patients with pain that is limited to a specific area of the body, DRG therapy often works where other treatments may not—or provide only partial relief. That’s because the DRG corresponds to specific anatomical locations in the body and relays information, such as pain signals, to the brain. Because of its unique ability to target the areas of the body where pain occurs, DRG therapy can be especially helpful for patients like you.

MORE THAN 300,000 PEOPLE  HAVE SUCCESSFULLY RECEIVED NEUROSTIMULATION SYSTEMS  OVER THE PAST 40 YEARS.

THE DRG SYSTEM.  IT’S THIS SIMPLE.

THE DRG NEUROSTIMULATOR SYSTEM CONSISTS OF THREE COMPONENTS:

THE GENERATOR – a small device that sends out mild electrical pulses, which contains a battery. This is implanted in your body.

THE LEADS – thin insulated wires that carry the electrical pulses from the generator to your dorsal root ganglia. These are placed in your body in the area of the DRG.

THE PATIENT CONTROLLER – a handheld “remote control” that allows you to adjust the strength and location of stimulation or even turn stimulation off.
Placement of the DRG system is similar to that of other neurostimulation devices.

MAKE SURE DRG THERAPY WORKS FOR YOU. TRY IT OUT FIRST.

One of the benefits of the DRG neurostimulation system is that you can be fitted with a temporary device that works like an implanted system but can be removed. This allows you to determine its effectiveness for your pain prior to undergoing an implant. You will have a short, minimally-invasive procedure, during which you are awake and answering questions. Your doctor will:

  • Implant a few small, thin leads near your DRG.
  • Attach the leads to a temporary generator that you can wear outside of your clothing or on your belt.
  • Ask you to provide feedback on where you feel stimulation.

Afterward, you will be trained to use the device and find the settings that feel best.

While you wear the temporary system you will be asked to limit physical activities that involve lifting, bending, twisting or raising your arms above your head. Otherwise, you will be able to resume daily living. Look forward to the ability to do and enjoy things, like sleeping, walking and shopping, that were once difficult. Life more like you remember it—before the pain.

Look forward to the ability to do and enjoy things, like sleeping, walking and shopping, that were once difficult. Life more like you remember it— before the pain.

DRG THERAPY WORKS! NOW WHAT?

Now, it’s time to talk to your doctor about having the system implanted.

You will need to stop the temporary stimulation briefly before the surgery to implant the generator. You’ll likely be admitted to a surgery center and some of the components of the temporary system may be removed. The implant does involve a minimallyinvasive surgical procedure that includes implanting the generator under your skin. It’s important that you discuss with your doctor all of the complications associated with an implanted neurostimulation device and whether you are at risk.

The generator will be implanted with leads that will be placed close to the target dorsal root ganglia identified during the temporary evaluation. As with the evaluation procedure, you will be awake and answering questions. Within a few days, your system should begin working just like before.

WHAT ARE THE RISKS ASSOCIATED WITH THIS PROCEDURE?

The placement of a neurostimulation system requires surgery, which exposes patients to certain risks. Complications such as infection, swelling and bruising are possible. Additional risks such as undesirable changes in stimulation may occur over time. Be sure to talk to your doctor about all the possible risks associated with neurostimulation.

WHAT ARE SOME OF THE RESTRICTIONS I MAY HAVE WITH AN IMPLANTED SYSTEM?

Your doctor will give you detailed information about restrictions and activities with your system. As a general rule, however, it is important to restrict the amount of bending, twisting and reaching you do for the first six to eight weeks after surgery. This is the time that the healing is taking place around the leads. There are also some permanent restrictions associated with receiving a neurostimulation system. Be sure to ask your doctor for a complete list of restrictions.

PROOF OF EFFECTIVE RELIEF FOR PATIENTS LIKE YOU.

THE LARGEST  NEUROSTIMULATION  CLINICAL TRIAL  EVER CONDUCTED AMONG PATIENTS with chronic intractable lower limb pain typically resulting from a previous injury, the ACCURATE clinical study, showed that with DRG therapy:

  • 74.2% of DRG patients had pain relief at 12 months.
  • 94.5%of DRG patients did not experience stimulation outside  of their primary area of pain at 12 months.
  • DRG patients had an average of 81.4% REDUCTION in their pain at 12 months.

LIVE A LIFE TRANSFORMED.

There is no cure for most conditions that cause difficult-to-treat isolated chronic pain. But DRG therapy can interrupt that pain allowing you to enjoy the simple things in life again. Sleep well, work at the job you love, take a walk after dinner. Without the pain, you can live a life transformed.

CONTACT YOUR DOCTOR FOR MORE INFORMATION.

To learn more about DRG therapy, please speak with your physician and visit http://www.sjm.com/pain.

 

Hip Injections

Nevada Comprehensive Pain CenterBecause the hip joint is quite deep and tight, a long thin needle is used. A special x-ray is utilized for guidance in properly targeting and placing the needle, and for avoiding nerve or other injury.

Once the needle appears to be in the correct position, several drops of contrast dye are then injected to make sure that the tip of the needle is actually inside the hip joint. A small mixture of local anaesthetic to give rapid pain relief plus a steroid which acts as a very powerful anti-inflammatory is often injected into the joint.

Hip injections are normally done as a quick day-case procedure with the patients awake and they are able to go home 30-60 minutes after the procedure.
Patients may or may not obtain pain relief in the first few hours after the injection, depending upon whether or not the joint that was injected is the main source of the patient’s pain. On occasion, the patient may feel numb or experience a slightly weak or odd feeling in the leg for a few hours after the injection.

Occipital Nerve Stimulator

Occipital Nerve StimulatorThis procedure works by targeting one or more of the occipital nerves (greater, lesser, and third occipital nerves). In certain headache syndromes, other nerves may be targeted. A small amount of electrical current is introduced to these nerves which tricks the brain into turning off (or significantly attenuating) the painful signals.

Prior to implantation, a trial is performed in which leads are placed under the skin and are connected to an external battery. The trial is performed under sedation, and the patient is discharged the same day. Afterward, the patient tries the therapy for 4-7 days and keeps a detailed pain diary.
A permanent device is implanted only if the patient reports significant improvements in pain and quality of life. The permanent implantation is placed under sedation or anesthesia, and the patient is discharged the same day.

The device is programmed by a clinical specialist appointed by the manufacturer.

Patients with the following conditions who have failed all standard medical therapies may benefit: Occipital neuralgia, whiplash-related headaches, other neck-related headaches, and nerve injuries from trauma or previous surgery, occasionally cluster headaches.

Peripheral Nerve Stimulator

Peripheral Nerve StimulatorPeripheral nerve stimulation is a technique in which a small amount of electrical current is introduced to the nerves along the course of peripheral nerves to control pain.

The patient experiences this as a pleasant tingling sensation. By stimulating nonpainful sensory pathway, the electrical current tricks the brain into turning off (or significantly attenuating) the painful signals. In this manner, pain relief occurs. In general, most patients are then able to reduce or discontinue altogether their pain medications.

Nerve stimulation is performed in a two-step process. First there is a temporary trial electrode. This is left in place for a week or so, so that the patient may determine if peripheral nerve stimulation is helpful. The electrode is connected to an external power supply that the patient controls. In the event that the stimulator does not help, it is removed. If it does help, the temporary electrode is replaced with a permanent electrode that is then connected to an internal battery pack, similar to a pacemaker battery. Once in place, the patient may then resume normal activities of daily living, including swimming, exercise, and work.

Patients with the following conditions who have failed all standard medical therapies may benefit: Complex regional pain syndromes, nerve injuries from trauma or previous surgery or long-standing back pain.

Spinal Cord Stimulator

Nevada Comprehensive Pain CenterSpinal cord stimulation is a procedure that uses mild electrical impulses to the spine to treat chronic pain due to a variety of conditions, including failed back surgery, neuropathic pain/neuropathy and complex regional pain syndrome/reflex sympathetic dystrophy.

A small pulse generator sends electrical pulses to the spinal cord. These pulses interfere with the nerve impulses that make you feel pain replacing them with a tingling sensation.

Implanting the stimulator is typically done using a local anesthetic and a sedative. Your doctor usually will first insert a trial stimulator through the skin to give the treatment a trial run. If the trial is successful, your doctor can implant a more permanent stimulator. The stimulator itself is implanted under the skin of the belly (abdomen), and the small coated wires (leads) are inserted under the skin to the point where they are inserted into the spinal canal. This placement in the abdomen is a more stable, effective location.

Using a handheld device that works like a remote control, you can adjust the stimulator to specific areas and levels of pain, depending on your activities and how your pain changes during the day.

Peripheral Nerve Block

Peripheral Nerve BlockPeripheral nerve blocks are generally done to control pain arising from a nerve, also known as neuralgia. Nerve injury can be caused by trauma, compression, ischemia, or toxic exposure to a nerve.

In general, a combination of cortisone and long-acting local anesthetic is injected in proximity to the injured nerve in order to provide pain relief and reduce nerve irritation. These procedures are usually done at bedside and take only a few minutes.
Commonly performed peripheral nerve blocks include:

 

  • Median nerve blocks for carpal tunnel syndrome.
  • Ilioinguinal nerve blocks for groin pain after hernia surgery, or due to compression from tight fitting belts, or trauma.
  • Neuroma injections for Morton’s neuroma, or neuroma formation after surgical injury to a nerve (Neuroma is a benign growth on nerve endings that spontaneously transmit pain signals).
  • Sciatic or femoral nerve blocks for leg or knee pain.

Stellate-Ganglion Block

Stellate-Ganglion BlockA stellate ganglion block is an injection of a small amount of local anesthetic and steroid (anti-inflammatory) in the sympathetic nerve tissue of the neck which is located on either side of the voice box.

It blocks the nerves that go to the arms and to some degree the sympathetic nerves that go to the face. This may in turn reduce pain, swelling, color and sweating changes in the upper extremity and may improve mobility.

It may be performed if you are experiencing facial pain, neck pain, or arm pain as a result of the following: shingles affecting the trigeminal nerve or cervical and upper thoracic dermatomes; acute vascular insufficiency of the face and arms; chronic regional pain syndrome (RSD) of the face, neck, arms, and upper thorax; Raynaud’s syndrome of the arms; phantom limb pain; and sympathetically mediated pain from cancer.

Sympathetic Block

This therapy targets the sympathetic nervous system, a series of nerves that spread out from your spine to your body to help control several involuntary body functions. These include blood flow, digestion, urination, sweating and sexual arousal.
Your sympathetic nerves come together outside your spine area in thick networks of nerves called ganglions.

When these nerves are irritated or injured, the blood supply to your hands, feet, or other areas may be affected and can produce pain or sensory changes. Headaches, neck pain, and facial pain can also be seen in patients who have sympathetic nerve dysfunction.

A sympathetic nerve block involves injecting a local numbing anesthetic and a corticosteroid into the space where the sympathetic nerve ganglion is located. The entire procedure takes less than 15minutes and x-ray guidance is used to ensure proper needle position.

Occipital Nerve Radiofrequency Denervation

Nevada Comprehensive Pain CenterThose with occipital neuralgia have jabbing pain in the areas of the greater or lesser occipital nerves, or the third occipital nerve. The pain is usually in the lower back of the head on one side, though it can spread to other areas. Usually there is also tenderness over the nerve.
Patients may be selected for Occipital Nerve Radiofrequency Denervation because it has good efficacy for this condition.

Occipital Nerve Block

Occipital Nerve BlockAn occipital nerve block is an injection of a steroid around the greater and lesser occipital nerves that are located on the back of the head just above the neck area.

The steroid injected reduces the inflammation and swelling of tissues around the occipital nerves. This may in turn reduce pain and other symptoms caused by inflammation or irritation of the nerves and surrounding structures. Typically, headaches over the back of the head, including certain types of tension headaches and migraine headaches, may respond to occipital nerve blocks.

The actual injection takes only a few minutes. It is done with the patient seated or lying down. The skin and hair of the back of the head are cleaned with antiseptic solution and the injection is carried out.