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Neuromodulation with electrical field stimulation of dorsal root ganglion in various pain syndromes: a systematic review with focus on participant selection

Authors Vuka I, Marciuš T, Došenović S, Ferhatović Hamzić L, Vučić K, Sapunar D, Puljak L

Received 15 October 2018

Accepted for publication 17 January 2019

Published 27 February 2019 Volume 2019:12 Pages 803—830


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Dr Michael A Überall

Ivana Vuka,1 Tihana Marciuš,1 Svjetlana Došenović,2 Lejla Ferhatović Hamzić,3 Katarina Vučić,4 Damir Sapunar,1,5,* Livia Puljak5,*

1Laboratory for Pain Research, University of Split School of Medicine, 21000 Split, Croatia; 2Department of Anesthesiology, Reanimatology and Intensive Care, University Hospital Split, 21000 Split, Croatia; 3Department for Proteomics, Center for Translational and Clinical Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia; 4Department for Safety and Efficacy Assessment of Medicinal Products, Agency for Medicinal Products and Medical Devices, 10000 Zagreb, Croatia; 5Center for Evidence-Based Medicine and Health Care, Catholic University of Croatia, 10000 Zagreb, Croatia

*These authors contributed equally to this work

Objective: We conducted a systematic review about patient selection, efficacy, and safety of neuromodulation with electrical field stimulation (EFS) of dorsal root ganglion (DRG) in various painful conditions. We also analyzed conclusion statements as well as conflict of interest and financing of the included studies.
Methods: All study designs were eligible for inclusion. We searched MEDLINE, CINAHL, Embase, PsycINFO, and clinical trial registries until September 7, 2018. We assessed risk of bias by using Cochrane tool for randomized controlled trials (RCTs).
Results: Among the 29 included studies, only one was RCT, majority being case series and case reports. The evidence is based on studies with small number of participants (median: 6, range 1–152) with various painful conditions. Neuromodulation with EFS of DRG was mostly performed in participants who have failed other treatment modalities. Most of the authors of the included studies reported positive, but inconclusive, evidence regarding efficacy of neuromodulation with EFS of DRG. Meta-analysis was not possible since only one RCT was included.
Conclusion: Available evidence suggest that neuromodulation with EFS of DRG may help highly selected participants with various pain syndromes, who have failed to achieve adequate pain relief with other pharmacological and nonpharmacological interventions. However, these findings should be confirmed in high-quality RCTs with sufficient numbers of participants.

Keywords: DRG, pain, neuropathic pain, chronic pain, neurostimulation, electrical stimulation

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