• Timothy R Deer, Robert M Levy, Jeffery Kramer, Lawrence Poree, Kasra Amirdelfan, Eric Grigsby, Peter Staats, Allen W Burton, Abram H Burgher, Jon Obray, James Scowcroft, Stan Golovac, Leonardo Kapural, Richard Paicius, Christopher Kim, Jason Pope, Thomas Yearwood, Sam Samuel, W Porter McRoberts, Hazmer Cassim, Mark Netherton, Nathan Miller, Michael Schaufele, Edward Tavel, Timothy Davis, Kristina Davis, Linda Johnson, and Nagy Mekhail.
• Center for Pain Relief, Charleston, WV, USA.
• Pain. 2017 Apr 1; 158 (4): 669-681.

AbstractAnimal and human studies indicate that electrical stimulation of dorsal root ganglion (DRG) neurons may modulate neuropathic pain signals. ACCURATE, a pivotal, prospective, multicenter, randomized comparative effectiveness trial, was conducted in 152 subjects diagnosed with complex regional pain syndrome or causalgia in the lower extremities. Subjects received neurostimulation of the DRG or dorsal column (spinal cord stimulation, SCS). The primary end point was a composite of safety and efficacy at 3 months, and subjects were assessed through 12 months for long-term outcomes and adverse events. The predefined primary composite end point of treatment success was met for subjects with a permanent implant who reported 50% or greater decrease in visual analog scale score from preimplant baseline and who did not report any stimulation-related neurological deficits. No subjects reported stimulation-related neurological deficits. The percentage of subjects receiving ≥50% pain relief and treatment success was greater in the DRG arm (81.2%) than in the SCS arm (55.7%, P < 0.001) at 3 months. Device-related and serious adverse events were not different between the 2 groups. Dorsal root ganglion stimulation also demonstrated greater improvements in quality of life and psychological disposition. Finally, subjects using DRG stimulation reported less postural variation in paresthesia (P < 0.001) and reduced extraneous stimulation in nonpainful areas (P = 0.014), indicating DRG stimulation provided more targeted therapy to painful parts of the lower extremities. As the largest prospective, randomized comparative effectiveness trial to date, the results show that DRG stimulation provided a higher rate of treatment success with less postural variation in paresthesia intensity compared to SCS.

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