Selective L3 DRG stimulation vs b/l Genicular Nerve block

[gator2886]

Discuss and also for those of you doing selective DRG stim are your patients asleep? Sedated? ASC vs clinic? Anyone doing them under local?

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[Ligament]

One is in the head, the other in the lumbar spine...not sure why you'd be comparing them?

 

[gator2886]

I meant Genicular Nerve

 

[lobelsteve]

Why would you offer SCS before anything less invasive?
And OA is a poor indication for SCS. And CRPS post-TKA is a cop-out.

 

[deleted472101]

I think the world of Neuromodulation is opening up larger than it was confined to in previous years. If we hold on to beliefs that Neuromodulation fits certain small criteria then we will never advance this field and potentially help many.

I don’t think Neuromodulation cures all but in the past few years I have seen the indications grow since the field has gotten better since the old days.

Between HF10, HF, Burst DR and DRg we have seen things change since old tonic days.

To answer the original post, DRG works for neuropathic Pain probably won’t work for nociceptive Pain.

 

[Pain_doc]

I like DRG for focal pains once everything else has failed.....if its indicated and you can get it approved. Some amazing results with DRG, though I have not done any for knee pain after TKA.

 

[lobelsteve]

It sounds like a great way to make a buck at the expense of experimenting on patients

 

[SommeRiver]

This is a no brainer...Of course you would go the way of the genicular block and possible RFA if the block works. What is the indication for DRG stim in this case? If it is chronic knee pain strictly due to OA the stimulator is absolutely not indicated.

I have a good amount of persistent post surgical knee pain patients and I can honestly say I only have two with legit CRPS, and both have had over 10 knee surgeries. These are like motorcycle wreck ppl with septic joints, severe gross deformities, and they have Budapest criteria.

Your typical arthroscopy twice then the TKR and the knee still hurts is not CRPS. It is PPSP and you should ablate them, manage meds, TENS, and offer a referral to pain psych (good luck on pt buy in). I would hope they've finished PT and are religious with a home exercise plan.

 

[callmeanesthesia]

This is a no brainer...Of course you would go the way of the genicular block and possible RFA if the block works. What is the indication for DRG stim in this case? If it is chronic knee pain strictly due to OA the stimulator is absolutely not indicated.

I have a good amount of persistent post surgical knee pain patients and I can honestly say I only have two with legit CRPS, and both have had over 10 knee surgeries. These are like motorcycle wreck ppl with septic joints, severe gross deformities, and they have Budapest criteria.

Your typical arthroscopy twice then the TKR and the knee still hurts is not CRPS. It is PPSP and you should ablate them, manage meds, TENS, and offer a referral to pain psych (good luck on pt buy in). I would hope they've finished PT and are religious with a home exercise plan.

Overall I agree with you. Also lots of people who had legit CRPS and it gets better in a few months or a year, but they continue to have pain from other sources so it keeps getting called CRPS. I’ve had some good luck with RF in that population as long as the allodynia is controlled first.

Still, a lot of PPSP pain is neuropathic or mixed in nature, so I don’t think it’s unreasonable to see a role for stim. I’m not personally jumping on that train but I don’t think people who are doing it are just being greedy.

 

[TIVAndy]

my personal anecdotal experience. - long time pt of mine with bilateral TKA, severe pain post op that persisted preventing her from ambulating much. i did genicular bilaterally, left knee with 100% pain relief for 1 year and right not so much improvement. I even repeated a specific infrapatellar saphenous RF on the right knee but didn't help. sent to joint ortho to consider any operable issue/revision but pt adamantly refused any possible revision. after 1 year pain in left knee came back. due to persistent pain in right knee and left knee pain coming back i did bilateral DRG L3. patient with 100% pain relief so far. pt is walking now, weaned opioids. whether we want to call the pain CRPS or PPSP, she definitely had strong component of infrapatellar saphenous pain/neuropathic pain and DRG stimulation is helping her so far. i don't think i would have achieved this result with regular dorsal column stim. whether this benefit would last for long time is another question.

 

[Sadder]

i did bilateral DRG L3. patient with 100% pain relief so far. pt is walking now, weaned opioids. whether we want to call the pain CRPS or PPSP, she definitely had strong component of infrapatellar saphenous pain/neuropathic pain and DRG stimulation is helping her so far.

U did DRG L3 as single shot or implant device?

 

[lobelsteve]

Anecdote does not equal data.

 

[deleted472101]

That’s why it is medicine and not a check box profession.

 

[Ducttape]

medicine should be done with evidence to back it up. we are not snake oil salesmen.





then again, maybe we are. ive been around long enough to see whats happening with neuromodulation the same as what had happened before with other medical therapies, including interventional spine, interventional orthopedics, opioids, ketamine, etc. it maybe works for 1 condition. of course, it works for everything.

think THC. the one drug that prevents some seizures, but now "cures" anxiety, pain, stress, PTSD, cancer and tumors, arthritis, dementia, glaucoma, CF, migraines, systemic infections, emphysema........