Dorsal Root Ganglion Stimulation for Complex Pain Syndrome Secondary to Gunshot Injury

• Published in: Pain medicine (Malden, Mass.) Mass.), 2019-03, Vol.20 (3), p.615
• Main Authors: West, Ryan, Timchenko, Alexander, McCallin, John P
• Format: Article
• Language: English
• Subjects: Care and treatment; Case studies; Complex regional pain syndromes; Complications and side effects; Gunshot wounds; Neural stimulation
• ISSN: 1526-2375

Introduction: Dorsal root ganglion (DRG) stimulation is a Food and Drug Administration-approved treatment for treating complex regional pain syndrome, which typically originates from one or two peripheral nerves. We present a case of a complex chronic pain pattern following a gunshot wound (GSW) to the abdomen that was not isolated to a single nerve. Case: We report on a US Army soldier treated at a level 1 military trauma center for a complex chronic pain pattern following a GSW to the abdomen. He suffered from severe, debilitating, and poorly controlled complex pain in the left lower extremity, left lower abdomen, and left flank following a penetrating GSW to the abdomen and left flank area. Multiple treatment modalities were attempted initially, including medication management, physical therapy, and complimentary and integrative treatment techniques. The patient continued to experience significant pain with severe impact on the quality of life and limitation to activities of daily living. Results: DRG stimulation was used to target the DRG of left T11 (to cover neuropathic lower abdominal pain on the left), left L2 (to cover no-ciceptive axial low back pain and neuropathic posterior flank pain), and S1 (to cover neuropathic pain in the left postero-lateral thigh and calf). The patient reported complete resolution of his pain condition with trial stimulation and subsequent implantation. Patient reported significant improvement of the quality of life and functionality. Conclusion: DRG stimulation offers an efficient alternative modality for treatment of a complex pain pattern involving several areas. References: 1) Morgalla M, Fortunato M, Lepski G, Chander B. Dorsal root ganglion stimulation (DRGS) for the treatment of chronic neuropathic pain: A single-center study with long-term prospective results in 62 cases. Pain Physician 2018;21(4):E377-87. 2) Deer TR, Levy RM, Kramer J, et al. Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and causalgia at 3 and 12 months: A randomized comparative trial. Pain 2017;158(4):669-81. 3) Liem L, Russo M, Huygen FJ, et al. One-year outcomes of spinal cord stimulation of the dorsal root ganglion in the treatment of chronic neuropathic pain. Neuromodulation 2015;18(1):41-8.