A Narrative Review of the Dorsal Root Ganglia and Spinal Cord Mechanisms of Action of Neuromodulation Therapies in Neuropathic Pain

Brain Sci., 2024 · DOI: 10.3390/brainsci14060589 · Published: June 9, 2024

Spinal Cord Injury Neurology Pain Management

Simple Explanation

Neuropathic pain results from nervous system injuries due to diseases like diabetes, infections, toxicity, and trauma, involving both peripheral and central pathological changes. Neuromodulation is emerging as a therapeutic approach for neuropathic pain, especially in patients unresponsive to common treatments, by normalizing neuronal and glial activity. This review focuses on the dorsal root ganglia and spinal cord neuromodulation, aiming to understand its therapeutic mechanisms for neuropathic pain management.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Level 5, Narrative Review

Key Findings

1
Neuromodulation therapies in the DRG and spinal cord decrease hyperalgesic cytokine production, including TNF-α, IL-1β, IL-6, and HMGB1.
2
Neuromodulation promotes opioid signaling and activates descending analgesic pathways within the spinal cord, aiding in pain relief.
3
Neuromodulation therapies reduce glial cell activity and pro-inflammatory mediators in the spinal cord, further decreasing neuropathic pain.

Research Summary

Neuropathic pain involves complex interactions of biological, social, and psychological factors, characterized by amplified nociceptive signaling in the PNS and CNS. Neuromodulation offers potential therapeutic avenues for treating neuropathic pain, with options like DRG stimulation, high-frequency SCS, and burst SCS providing tailored treatment strategies. Studies suggest that neuromodulation targeting the DRG and spinal cord has benefits, involving molecular and tissue-level effects, impacting cytokine production and glial cell activity.

Practical Implications

Personalized Treatment Selection

A deeper understanding of tissue-dependent molecular and cellular mechanisms can aid in precisely selecting the appropriate neuromodulation approach for personalized treatment.

Advancements in Clinical Application

New options such as DRG stimulation and high-frequency SCS offer different approaches to tailor treatment strategies for patients with neuropathic pain.

Future Research Directions

Continued translational and clinical studies are crucial for better understanding the effectiveness, adverse events, and applicability of neuromodulation therapies.

Study Limitations

1
Varied etiologies make neuropathic pain management complex.
2
Neuromodulation therapy may have limitations and varying quality of evidence.
3
Clinical trials with large sample sizes are needed to determine the magnitude of effect.

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