Treatment Philosophy

Excel Pain and Spine is a privately-run practice owned and operated solely by physicians that have trained, taught, and researched at the top pain medicine institutions in the country.

Our physicians are regarded experts in the pain management field and remain involved with teaching new and advanced treatments to practicing physicians, residents, medical students, and fellows across the county.

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Treatments - Dorsal Root Ganglion Stimulation


Dorsal root ganglion stimulation (DRG) is a treatment modality using a small implantable wire and implantable battery. This treatment is used to block severe nerve pain signals. The dorsal root ganglion is a part of the nerve that controls and processes pain before sending the signal through the spinal cord to the brain. Using a very small amount of electricity the DRG can be inhibited or blocked. Each DRG corresponds to a particular part of the body or dermatome. Using anatomic mapping particular areas are treated or targeted for relief. The benefit of this therapy is the precision and ability to focus on specific areas that otherwise could not be treated with conventional measures.

First a temporary trial is performed for 5-8 days. During this trial temporary lead(s) or wire(s) are placed using a small needle over the DRG. Patients try the device to determine if it is beneficial during this 5–8-day period of time. After this period of time the trial leads are removed and a discussion is completed to determine if a permanent implant will be performed.

The permanent implant is an outpatient procedure using 2-3 small incisions for the placement of new sterile leads and battery.

The goal of the DRG stimulator is to help you to better manage your pain and potentially decrease the amount of pain medication you needed. Stimulation does not eliminate the source of pain; it simply interferes with the signal to the brain. The goal for relief is a 50-100% reduction in pain.


What conditions are treated with dorsal root ganglion stimulation?
There are many neuropathic pain or nerve pain conditions treated with DRG stimulation. This treatment is commonly used to treat the following conditions: mononeuropathy, pain after trauma, complex regional pain syndrome (CRPS), neuropathy, pain after total joint surgery, and pelvic pain. Most patients with these conditions experience 50-100% relief.

Overview of the DRG Trial and Permanent Implant Process:

Stage 1a: Pain Physician visit (evaluate your pain condition to determine whether your pain syndrome can be helped with a DRG stimulator).

Stage 1b: Diagnostic imaging and lab ordering (an MRI may be ordered to determine whether you have enough spinal space to have a lead safely placed).

Stage 2: Psychological evaluation (to understand your needs and expectations of therapy, also a requirement of insurance companies).

Stage 3: Trial stimulation (to evaluate the effectiveness of pain reduction, 5-8 days).

Stage 4: Permanent implantation (this may be performed by your pain physician or occasionally a spine surgeon depending on your pain syndrome needs).

The surgical procedure will entail placement of the leads in the epidural space of the spinal cord near the DRG and placement of the battery in the buttock or flank.

How is the procedure performed?
Our team will help position you to make sure the procedure can be completed with the least amount of discomfort for you. An IV is placed and antibiotics are given. The skin is cleansed with a sterilizing solution (chlorhexidine) and a sterile drape is placed. A local anesthetic medication typically (lidocaine) is given to numb the skin. Next, fluoroscopy (x-ray) or ultrasound is used to find the target. For the implant 2-3 small incisions are made.

The physician will provide local anesthesia (numbing medicine) and place the needle into your epidural space. They will then place the dorsal root ganglion lead into position. This will all be done under x-ray. Once it is in the right place, the representative from the company will help program it to make sure it is in the best possible location for each patient. Once this is accomplished, the needle is removed and the lead is sutured in place. All the wounds are closed with sutures and or staples. During the entire procedure you will be constantly monitored by our team. You will be given time after the procedure to make sure you feel good and are not having side-effects before leaving the clinic.

Does the procedure hurt?
The procedure is typically well tolerated. Mild to moderate soreness for a week after the procedure is normal. Medications for pain are often provided.
How long does the procedure take?
The procedure typically takes about 1-2 hours to perform. Please plan on being at the clinic for about 3-4 hours to allow for pre and post-procedural safety protocols.

Can I have the injection if I have diabetes?
Yes. It is important to control your blood sugar before and after the procedure. Diabetic patients may experience a temporary increase in blood sugar which should be monitored closely for days following the procedure. Uncontrolled diabetes increases the risk of wound or device infection.

What are the risks and side effects?
Risks and side effects are minimal and serious complications are rare. We take every precaution to ensure safety. Potential risks may include but are not limited to: vasovagal response (passing out), new or increased pain, infection, bleeding, permanent skin changes, allergic or unexpected drug reaction with minor or major consequences, and unintended nerve injury.

Pre-Procedure Information

Please let us know if you have an active infection, are using antibiotics, or are using blood thinners.

Should I take my normal medications as scheduled?
Yes. Continue taking your prescribed medications prior to procedure.

What if I am on a blood thinner or Aspirin?
Anticoagulation is often stopped for a short period of time prior to injection. Please speak with your primary physician if you take blood thinners to make sure that you can safely stop taking these medications.

Do I need a driver?
Yes. For your safety we require a driver to ensure a safe return home.

Can I eat the day of the procedure?
Do not eat any after midnight the night before the procedure. You must fast for at least 8 hours prior to the procedure.

Can I get sedation or anesthesia?
IV anesthesia is used and patients typically do not require a breathing tube. The anesthesia is similar to what is provided for a colonoscopy.

What if I am pregnant?
There are serious potential risks to an unborn fetus when exposed to imaging studies, including x-ray and fluoroscopy. If there is any chance you may be pregnant, please postpone this procedure until it can be confirmed that you are not pregnant as it is not safe to do during pregnancy.

What should I wear?
We recommend light loose-fitting clothes. We will ask you to change into a gown.

Post-Procedure Information

When can I drive after the procedure?
We recommend limiting driving until you feel minor pain and are not requiring any additional medication.

What can I do if I am sore or have pain after the procedure?
Ice packs can be applied to the area for 20 minutes per hour. Over the counter Tylenol and Motrin can be used to aid with any discomfort. Prescription pain medications are sometimes provided.

What are my restrictions after the procedure?
You will have minor limitations for 6 weeks for the permanent implant. We recommend limiting any bending, lifting, or twisting. We recommend not lifting anything greater than 5 LBS. Following these limitations decreases the risk of lead migration or movement of the stimulator and/or leads.

When can I shower?
During the trial no showering is allowed during the 5-8 day test period. Only sponge baths are allowed.
For the implant there is no showering for 72 hours. At this point bandages can be removed. Showering using soap and water is okay. No submerging in water for 6 weeks.

When do I come back for a follow-up visit?
We follow-up with all of our patients after their procedures. We will see you in one week to remove the trial leads. We typically see our DRG implant patients back in 1-2 weeks and then again in about 4-6 weeks.

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