Dorsal Root Ganglion (DRG) Stimulation Therapy

What is dorsal root ganglion (DRG) stimulation?

Dorsal root ganglion stimulation, or DRG stimulation, is a relatively new treatment that offers significant pain relief for patients living with chronic intractable pain conditions. Cleveland Clinic Abu Dhabi is the only center offering this state-of-the-art treatment in the UAE.

The treatment has been proven to offer highly effective pain relief in patients who have not responded to traditional medical pain management or other interventional procedures. 

DRG stimulation is similar to traditional spinal cord stimulation (SCS) but involves implanting electrodes on the dorsal root ganglion a cluster of nerves in the posterior root of the spinal cord. These nerves act like the nerve center of the spinal cord and are able to modulate pain before it reaches the brain, making it less intense. 

What can DRG stimulation treat?

DRG stimulation can be used to treat chronic intractable pain conditions, which affect the lower extremities. These include:

• Neuropathic pain conditions including diabetic neuropathy 
• Isolated chronic pain 
• Chronic pain following foot, knee, groin, and other surgeries

What happens before the procedure? 

You will be asked to arrive at the Interventional Pain Management Center 30 minutes before your scheduled appointment. A patient access representative (PAR) will complete any necessary paperwork and your clinic registration. Please bring your insurance card and Emirates ID.

You will then see a pain management nurse who will review your medical history, your current medications, and perform a nursing physical assessment. 

You will then meet with your doctor for medical evaluation, who will help you to understand the procedure in detail. Your doctor m DRG stimulation and answer any queries you may have.

Before the procedure, an intravenous (IV) line may be placed in your arm. You will then be taken to the procedure room where you may be given a mild sedative to help you relax if necessary.

On the day of the procedure, you must fast at least 6 hours before your appointment, however, you may drink clear liquids up to 2 hours before the procedure. If you are diabetic and use insulin, you must adjust the dosage on the day of the procedure as instructed by your doctor.

You must tell your doctor if any of the following apply: 

• You are taking blood thinners (you will be instructed to temporarily discontinue this medication prior to your procedure). Please note, do not stop taking any medication without first talking to your doctor 
• You are nursing or may possibly be pregnant
• You have an active infection (your doctor may need to order some blood tests)

Please note:

• You should bring a responsible adult with you to drive and accompany you home after the procedure. 
• Discontinue any pain medication 4 hours before the time of your scheduled procedure. Continue to take all other medications (when you are instructed) with a small sip of water before coming for the procedure. Bring all medications with you so that you can take them after your procedure (only take what is due or as instructed by your doctor)

What happens during the procedure?

The DRG procedure usually takes around 60 minutes. You will be lying face down and sedated to reduce any pain. The procedure area (upper, middle, or lower back) will be cleansed with an antiseptic solution and a local anesthetic administered to numb the area.

Your doctor will use an X-ray to guide the placement of the lead in the spinal space. This is then connected to the pulse generator and implanted deep under the skin.

You will be woken up during the procedure to gauge your response of the stimulation and to ensure the correct placement of the leads. 

Once the procedure is completed, and you wake from sedation, you will be transferred to the recovery room. 

What happens after the procedure?

You will stay in the recovery room for about 30 60 minutes for observation where a nurse will check your vital signs and give you pain medicines if needed. You will be shown how to use and manage the stimulation device.

You will be given a drink and then your discharge instructions, including any medication for pain relief and infection prevention, will be discussed. A follow-up appointment with your doctor will also be scheduled for 1 2 weeks time.

Discharge Instructions:

• Do not drive or operate machinery for at least 24 hours after the procedure
• You may resume your normal diet
• Do not engage in strenuous activity for at least 4 weeks to allow healing of the wound
• Do not take a bath, swim or hot tub for at least 1 week; you may take a shower
• Do not remove the plaster 

Contact your doctor immediately or go to the nearest emergency room if you experience any of the following (inform the emergency room staff that you have recently had an epidural injection): 

• Weakness or numbness of your arms, legs or feet that does not resolve after eight hours
• Increased pain at the injection site, even after applying ice or moist heat pack
• Any bleeding from the incision site
• A headache that does not resolve with conservative treatment 
• Fever, chills, nausea, or vomiting. 
• Uncontrolled blood sugar or blood pressure
• Inability to control bowel or bladder
• Inability to urinate after 8 hours