Mechanisms of Action of Dorsal Root Ganglion Stimulation

Mechanisms of Action of Dorsal Root Ganglion Stimulation

22 March 2024 | Alaa Abd-Elsayed, Swarnima Vardhan, Abhinav Aggarwal, Madhurima Vardhan, Sudhir A. Diwan
The dorsal root ganglion (DRG) serves as a critical site for managing chronic pain through dorsal root ganglion stimulation (DRG-S). DRG-S has emerged as an attractive modality in neuromodulation therapy due to its accessibility and efficacy in alleviating chronic pain that is resistant to conventional treatments. Despite its therapeutic advantages, the precise mechanisms underlying DRG-S-induced analgesia remain unclear, partly due to the diverse sensory neuron population within the DRG and its modulation of both peripheral and central sensory processing pathways. Emerging evidence suggests that DRG-S may alleviate pain through several mechanisms, including reducing nociceptive signals at the T-junction of sensory neurons, modulating pain-gating pathways within the dorsal horn, and regulating neuronal excitability within the DRG itself. However, further exploration is needed to fully understand the mechanisms, particularly regarding its supraspinal effects and interactions with cognitive and affective networks. Understanding these mechanisms is crucial for optimizing neurostimulation technologies and improving clinical outcomes in chronic pain management. This review provides a comprehensive overview of the DRG anatomy, the mechanisms of action of DRG-S, and its significance in neuromodulation therapy for chronic pain.The dorsal root ganglion (DRG) serves as a critical site for managing chronic pain through dorsal root ganglion stimulation (DRG-S). DRG-S has emerged as an attractive modality in neuromodulation therapy due to its accessibility and efficacy in alleviating chronic pain that is resistant to conventional treatments. Despite its therapeutic advantages, the precise mechanisms underlying DRG-S-induced analgesia remain unclear, partly due to the diverse sensory neuron population within the DRG and its modulation of both peripheral and central sensory processing pathways. Emerging evidence suggests that DRG-S may alleviate pain through several mechanisms, including reducing nociceptive signals at the T-junction of sensory neurons, modulating pain-gating pathways within the dorsal horn, and regulating neuronal excitability within the DRG itself. However, further exploration is needed to fully understand the mechanisms, particularly regarding its supraspinal effects and interactions with cognitive and affective networks. Understanding these mechanisms is crucial for optimizing neurostimulation technologies and improving clinical outcomes in chronic pain management. This review provides a comprehensive overview of the DRG anatomy, the mechanisms of action of DRG-S, and its significance in neuromodulation therapy for chronic pain.
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