Comparison of Paresthesia Coverage of Patient's Pain: Dorsal Root Ganglion vs. Spinal Cord Stimulation. An ACCURATE Study Sub‐Analysis

• Published in: Neuromodulation (Malden, Mass.) Vol. 22; no. 8; pp. 930 - 936
• Main Authors: Deer, Timothy R., Levy, Robert M., Kramer, Jeffery, Poree, Lawrence, Amirdelfan, Kasra, Grigsby, Eric, Staats, Peter, Burgher, Abram H., Scowcroft, James, Golovac, Stan, Kapural, Leonardo, Paicius, Richard, Pope, Jason E., Samuel, Sam, Porter McRoberts, William, Schaufele, Michael, Burton, Allen W., Raza, Adil, Agnesi, Filippo, Mekhail, Nagy
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01.12.2019
• Subjects: ACCURATE study; Causalgia - therapy; CRPS; Digitization; Dorsal root ganglia; dorsal root ganglion stimulation; Female; Ganglia, Spinal; Humans; Male; Middle Aged; neuromodulation; Pain; Pain Management - adverse effects; Pain Management - methods; Pain Measurement; Pain Perception; Paresthesia; Paresthesia - epidemiology; Paresthesia - etiology; Reflex Sympathetic Dystrophy - therapy; Spinal cord; Spinal Cord Stimulation - adverse effects; Spinal Cord Stimulation - methods; Treatment Outcome; neuromodulation; ACCURATE study; dorsal root ganglion stimulation; paresthesia; CRPS
• ISSN: 1094-7159; 1525-1403; 1525-1403
• DOI: 10.1111/ner.12920

Objectives This was a sub‐analysis of the ACCURATE clinical trial that evaluated the accuracy and necessity of targeting paresthesia coverage of painful areas with dorsal root ganglion (DRG) stimulation vs. tonic spinal cord stimulation (SCS). Materials and Methods On diagrams of the torso and lower limbs, subjects marked where they felt pain at baseline and paresthesias at three months postimplant. Seventy‐five subjects (41 DRG and 34 SCS) with diagrams of sufficient quality were scanned, digitized, and included in this analysis. Subject completed diagrams were digitized and superimposed with a grid of 1398 squares. Quantification of the percentage of bodily areas affected by pain and stimulation induced paresthesias was performed. Results The percent of painful areas covered by paresthesia was significantly lower for DRG subjects than for SCS subjects (13% vs. 28% of the painful regions, p < 0.05), possibly because significantly more DRG subjects felt no paresthesia during stimulation when compared to SCS subjects (13/41 DRG vs. 3/34 SCS) (p < 0.05). The amount of paresthesia produced outside the painful areas (unrequired paresthesia) was significantly lower in DRG subjects than that of SCS subjects. On average, the percent of unrequired paresthesia was only 20% of the subjects' total painful body surface area in the DRG group compared to 210% in the SCS group (p < 0.01). Conclusions The results of this ACCURATE study sub‐analysis show that DRG stimulation produces paresthesias, on average, that are less frequent, less intense, with a smaller footprint on the body and less dependent on positional changes.