Some chronic pain travels. It moves up the leg, or down the arm, or shifts around the lower back, depending on the day. But there is another kind of chronic pain — just as real, often more stubborn — that settles into one specific spot and refuses to leave.
A foot that changed color after an injury. A hand that hurts if anything brushes against it. A groin or pelvic area that has burned for years after a surgery. If this sounds like your pain, there is a therapy most patients have never been told about. It is called DRG stimulation, and it was designed for pain with a specific target.
Quick Answer: What Is DRG Stimulation and Who Is It For?
DRG stimulation (also called DRG-S, short for dorsal root ganglion stimulation) is an implantable therapy designed for chronic pain that stays in one specific area of the body — most often a single foot, hand, knee, groin, or pelvic region.
It works by sending small electrical signals to a tiny cluster of nerve cells called the dorsal root ganglion. That cluster acts like a sorting station for sensation in one part of the body. When that station gets stuck firing pain signals, DRG stimulation can help quiet it down.
DRG-S is FDA-approved for complex regional pain syndrome (CRPS) of the lower limbs — chronic pain that often develops after an injury or surgery and continues long after the original injury has healed. It is also used for nerve pain after surgery, focal nerve injuries, and stubborn groin or pelvic pain.
Like other implantable therapies, DRG-S includes a 5-to-7-day trial phase with a temporary system, so you can test the therapy in your real life before committing to a permanent implant. The standard benchmark for moving forward is at least 50% pain relief during the trial. If the trial doesn’t work, the temporary leads come out — no permanent hardware was placed.
DRG-S is reversible and adjustable. The system can be reprogrammed, optimized, or removed if the therapy is no longer needed.
→ If you have nerve pain that lives in one specific area of your body — or if you have been diagnosed with CRPS — request an evaluation at Vertrae® in Dayton to find out whether DRG stimulation may be the right fit.
Read the Full Video Transcript
DISCLAIMER:
Transcript lightly edited for clarity and readability. The views expressed are intended to explore the full range of clinical considerations in spine care and do not constitute medical advice. Outcomes vary by patient and pain pattern. For guidance specific to your situation, consult a spine specialist.
Some chronic pain travels. It moves up the leg, spreads across the back, or shifts from one area to another. But there is another kind of chronic pain that settles into one specific spot — and refuses to leave. It may be a foot that changes color after an injury, a groin area that burns constantly after surgery, or a hand, ankle, knee, or limb that remains painfully sensitive long after the original injury should have healed.
Patients with this type of highly localized pain often face a frustrating cycle. The original injury may heal, the MRI may show no clear structural problem, and medications that help other types of pain may barely make a difference. But that does not mean the pain is imaginary. In many cases, this type of pain is driven by a localized neurological misfire — abnormal pain signaling that standard imaging simply cannot show.
If you have spent years being told your pain is “out of proportion,” or that nothing is wrong because your scans look normal, you need to hear this: you are not imagining it. There are recognized clinical conditions that can cause severe, persistent, localized nerve pain. One of the best-known examples is Complex Regional Pain Syndrome, or CRPS. Another is peripheral causalgia, also known as CRPS Type II, which can occur after a specific nerve injury.
These conditions often begin with a clear physical event — a broken wrist, an ankle sprain, surgery, trauma, or even what seemed like a minor injury. The tissues may repair themselves, but the nervous system in that specific area can remain overactive. The result is a disproportionate loop of pain, sensitivity, burning, color change, swelling, or abnormal sensation. Because this is a targeted neurological problem, it often requires a targeted neurological solution.
One important structure involved in this type of pain is called the dorsal root ganglion, or DRG. The DRG is a small cluster of nerve cells located just outside the spinal cord. It helps process sensory signals from specific areas of the body. You can think of the DRG like a sensory “mail room.” One DRG helps process signals from the foot, another may be connected to the groin, and another may correspond to the knee, hip, hand, or another specific region.
When localized nerve pain becomes chronic, the DRG associated with that painful area may become hypersensitive. Instead of accurately reporting what is happening in the body, it can repeatedly send false alarm signals to the brain. That is where DRG stimulation may help. DRG stimulation is an implantable therapy designed to deliver gentle electrical pulses near the specific dorsal root ganglion involved in the pain pathway.
Traditional spinal cord stimulation casts a broader field across the spinal cord. DRG stimulation is different because it allows physicians to target a more specific nerve structure associated with a more specific pain pattern. That precision can be especially useful for pain that is concentrated in difficult-to-treat areas, such as the foot, ankle, knee, groin, or certain post-surgical pain locations.
The goal is not to numb the body or cover up a structural problem. The goal is to help modulate abnormal nerve signaling — to quiet the false alarm and reduce the intensity of chronic neuropathic pain. For the right patient, that can mean more than a number on a pain scale. It can mean being able to wear a normal shoe again, sit through a meal, walk with less fear, sleep more comfortably, and return to parts of daily life that pain had taken away.
Clinical research supports DRG stimulation as an important option for carefully selected patients with chronic lower-extremity pain related to CRPS or causalgia. In the landmark ACCURATE clinical trial, researchers compared DRG stimulation with traditional spinal cord stimulation in patients with complex regional pain syndrome or causalgia affecting the lower limbs. At three months, 81% of patients treated with DRG stimulation achieved at least 50% pain relief, compared with 56% of patients treated with traditional spinal cord stimulation.
One of the major advantages of this therapy is that patients can usually test it before deciding on a permanent implant. This is called a temporary trial. During a brief outpatient procedure, a physician places temporary leads near the targeted DRG. The patient goes home the same day and spends several days testing the therapy during normal daily activities. A common benchmark for a successful trial is at least 50% pain reduction, along with meaningful improvement in function or quality of life.
If the trial does not provide enough benefit, the temporary leads are removed. If it does provide meaningful relief, the patient and physician can discuss whether a permanent DRG stimulation system is appropriate. This gives patients a real-world opportunity to understand whether the therapy may help before moving forward with a long-term implant.
DRG stimulation is not the right treatment for every type of chronic pain. It is generally best suited for focal, localized neuropathic pain — pain that is clearly concentrated in a specific region and appears to be driven by abnormal nerve signaling. Patients with widespread pain, moving pain, deep muscle aches, or structural spine problems may be better served by other treatments. That is why a careful evaluation matters.
At Vertrae® in Dayton, Ohio, Dr. Kamal Woods, dual fellowship–trained neurosurgeon and spine surgeon specializing exclusively in minimally invasive spine surgery, personally evaluates each DRG candidate to determine whether this therapy fits the patient’s diagnosis, pain pattern, and goals. Years of unexplained, localized nerve pain deserve more than dismissal. They deserve a precise evaluation — and, when appropriate, a precise treatment option designed to address the source of the signal.
Visit Vertrae.com to schedule your MotionFirst™ evaluation today.
Pain That Lives in One Place
There is a kind of chronic pain that doesn’t move. It doesn’t shift up the leg or down the arm. It stays. It stays in one foot, or one hand, or one specific patch of skin that became painful after an injury — and has been painful ever since.
Patients with this kind of pain often arrive at our office with a frustrating history. The pain has been explained away, missed, or under-treated for years. The imaging often shows something minor — or sometimes nothing at all. The medications that help other kinds of pain barely touch this one. And because the pain is in one specific area, it rarely fits the broader treatments most clinicians know.
There is a name for what happens inside the nervous system when pain becomes stuck in one specific area. It has to do with a small structure most patients have never heard of: the dorsal root ganglion.
The DRG: Your Body’s Mail Room for Sensation
Every part of your body — every foot, hand, patch of skin, muscle, and joint — sends sensory signals to your brain through a specific pathway. Those signals don’t travel directly. They pass through a sorting station first. That station is called the dorsal root ganglion, or DRG.
Think of it as the mail room for one specific neighborhood. There is one DRG at every level of the spine, on each side. Each one handles signals coming from one specific area of the body. The DRG at one level handles your foot. A different one handles your lower back. Another handles your groin. When signals reach the DRG, they get sorted and passed up the spinal cord to the brain.
When pain becomes chronic, the DRG for that specific area can get stuck. The nerve cells inside it become hypersensitive. They start firing pain signals in response to normal input — a light touch, a change in temperature, the seam of a sock. They can even fire on their own, with no trigger at all. The mail room is sending out alarm letters that nobody asked for, and it won’t stop.
For a long time, there was no therapy designed to reach this specific structure. Traditional spinal cord stimulation works at the spinal cord level — broader, less targeted. DRG stimulation was the first therapy built to go directly to the DRG itself.
You are not imagining this.
If you have chronic pain that lives in one specific area of your body, there is a real, named, recognized condition behind what you are feeling. There are real therapies built specifically for this. You deserve a real evaluation from someone who knows what to look for.
Who DRG Stimulation Helps
DRG stimulation tends to help patients with chronic pain that stays in one specific area of the body — pain that feels like burning, shooting, tingling, or that makes the skin sensitive to light touch. There are a few situations where it shows up most often.
Complex Regional Pain Syndrome (CRPS)
CRPS is the condition DRG stimulation was specifically built to treat. It usually starts with a specific injury — a broken wrist, an ankle sprain, a surgery. Sometimes it starts after something minor that didn’t seem serious at the time. The injury heals on imaging and on exam. But the pain in that one limb or area doesn’t heal with it. It becomes something different — and often worse than the original injury.
What CRPS often looks like: • Pain that has stayed — or gotten worse — long after the original injury should have healed • Burning, throbbing, or electric pain that stays in one specific limb or area • Color changes (red, blue, mottled), temperature changes (warmer or cooler than the other side), swelling, or skin texture changes • Extreme sensitivity — sometimes a sheet, a shirt sleeve, or a breeze can hurt • Limited movement in the affected area, sometimes with weakness or tremor |
CRPS can develop with or without a clear nerve injury. Both versions look similar in daily life and respond to the same treatments.
If you have CRPS, there is a chance you have spent years being told the pain is out of proportion, psychological, or not real. Many patients hear this from more than one clinician before anyone names the condition correctly. The reasons are simple: CRPS is uncommon, most physicians outside of pain medicine see very few cases, and the imaging often looks normal. In a system trained to find structural problems on scans, a patient with real, severe symptoms but no structural finding can easily be told that nothing is wrong.
CRPS is a recognized condition with specific clinical criteria. There are evidence-based therapies built for it. DRG stimulation is the only neurostimulation therapy with FDA approval specifically for CRPS.
“If you have been told your CRPS pain isn’t real, or that nothing can be done, I want you to hear this directly. CRPS is real. It is a recognized condition. And there is an evidence-based therapy that was designed for exactly what you have. You are not imagining this. You deserve a real evaluation.”
— Dr. Kamal Woods, MD, MBA │ Dual Fellowship-Trained Neurosurgeon │ Vertrae®, Dayton, Ohio
Other Situations Where DRG Stimulation Tends to Help
Beyond CRPS, DRG stimulation is used for several other types of nerve pain that stay in one specific area:
- Nerve pain after surgery — after hernia repair, knee surgery, ankle or foot surgery, or a C-section
- Nerve injury in one specific area — pain concentrated in a single nerve’s territory
- Stubborn groin or pelvic pain that hasn’t responded to other treatments
- Focal nerve pain that has not improved with medications, nerve blocks, or physical therapy
DRG-S is generally not the right fit when the pain is widespread, when it shifts across multiple body regions, when it’s primarily a deep muscle ache, or when there’s a structural problem on imaging that surgery could directly address.
Correctly identifying who is not a candidate matters as much as identifying who is. The evaluation at Vertrae® is built to determine whether your specific situation matches what DRG-S was designed for — or whether a different therapy makes more sense.
How DRG Stimulation Is Different from a Spinal Cord Stimulator
Most patients who learn about DRG stimulation have already heard about traditional spinal cord stimulation, or SCS. The two sound similar. Both are implantable. Both use electrical signals to change how the nervous system processes pain. Both include a trial phase. But they are built for different kinds of pain.
Traditional SCS — Broad Coverage
Spinal cord stimulation places thin leads just outside the spinal cord. The signals affect a broader area of the spinal cord, changing how it processes pain signals. SCS is generally well-suited to pain that is spread across a larger region — chronic back and leg pain, widespread nerve pain, or pain patterns that don’t fit one specific area.
DRG-S — Targeted to One Specific Area
DRG stimulation places much smaller leads right next to the specific dorsal root ganglion responsible for the painful area. Instead of covering a broad zone, it acts on one specific sorting station. This is what makes it so targeted — and what makes it well-suited for pain that lives in one specific place.
A practical difference patients often notice: because DRG-S is so targeted, it often works without producing the tingling sensation (called paresthesia) that some SCS systems create. And because the DRG sits in a stable spot, the relief tends to stay steady whether you’re standing, sitting, lying down, or bending over. The signal doesn’t shift with movement the way it sometimes can with older SCS systems.
Which One Is Right for Which Patient?
The short answer: it depends on where the pain lives and what is driving it. A patient with widespread chronic back and leg pain after spine surgery is often better matched to traditional SCS. A patient with CRPS in one foot, or pain in one specific groin region after a hernia repair, is often better matched to DRG-S. Some patients have a mix — and may benefit from one or the other depending on which pattern is more dominant.
This is exactly the decision the evaluation is built to make. There is no one-size-fits-all answer, and picking the right tool matters more than picking the newest technology.
How DRG Stimulation Works
The DRG stimulation system has two main parts. First, a small set of thin leads — similar to what is used in a pacemaker — placed near the specific dorsal root ganglion responsible for your pain. Second, a small battery unit, placed under the skin, usually in the lower back or upper buttock area. The two are connected by thin wires that run under the skin.
Once the system is in place and turned on, it sends small electrical signals to the DRG. Those signals change how the DRG processes incoming sensory information. The hypersensitive nerve cells that were firing pain signals for no good reason can settle down. The mail room stops sending alarm letters.
When the therapy works, patients describe being able to do things they couldn’t do before — wear normal shoes, accept a handshake, sit through a meal, sleep without the limb throbbing.
The implantation is performed as an outpatient procedure under general anesthesia. The leads are placed using imaging guidance, so the physician can position them precisely. The procedure typically takes one to two hours, and most patients go home the same day.
The Trial Phase: Testing Before Committing
One of the strongest features of DRG stimulation is that you get to test the therapy before committing to a permanent implant.
The trial typically lasts five to seven days. It starts with an outpatient procedure where thin temporary leads are placed near the target DRG using imaging guidance. You are sedated but comfortable throughout. After placement, the leads connect to an external pulse generator that you wear on a belt. The device is programmed to deliver DRG stimulation to your painful area, and you go home the same day.
For about a week, you live normally. You go to work. You sleep in your own bed. You walk around your house, run errands, sit through meals. You track how the therapy affects your pain and what activities become possible again.
At the end of the week, you meet with the care team and review the results together. The standard benchmark is at least 50% pain reduction along with meaningful functional improvement — being able to do things you couldn’t do before. If you reach that and want to move forward, the temporary leads are removed and a permanent system is placed in a second outpatient procedure.
If the trial doesn’t produce that level of relief, the temporary leads are simply removed in the office. No permanent hardware was placed. You have a clear answer, and you have lost nothing more than a week.
An unsuccessful trial is not a failure. It is the system working as designed — giving you concrete, real-life evidence about whether this therapy fits your specific pain, before you commit to anything permanent.
What the Research Shows
A landmark clinical trial called ACCURATE, published in 2017, compared DRG stimulation directly against traditional spinal cord stimulation in 152 patients with CRPS or related nerve-injury pain in the lower limbs.
- At three months, 81% of patients receiving DRG-S achieved at least 50% pain relief — compared with 56% for conventional SCS.
- The difference held at 12 months. DRG-S maintained its effectiveness while the SCS group showed more loss of effect over time.
- ACCURATE is one of the few direct head-to-head trials in the broader neuromodulation evidence base.
Beyond CRPS, supportive evidence has built up for DRG-S in other focal nerve pain conditions — post-surgical nerve injury, focal nerve injuries, and chronic groin or pelvic pain after surgeries like hernia repair. Pooled analyses of DRG-S for groin pain have reported responder rates around 80%, making it one of the most consistently supported areas in the DRG-S evidence so far.
Note: Trial results describe what happened in a specific group of patients under study conditions. Individual results vary. The evaluation is where the evidence and your specific situation come together.
What DRG Stimulation Can’t Do
A fair conversation about any therapy includes what it can’t do.
DRG-S has its strongest evidence for CRPS of the lower limbs — that is its FDA-approved use. For the other situations in which DRG-S is used (nerve pain after surgery, focal nerve injuries, groin and pelvic pain), the evidence is supportive but smaller and less uniform than the evidence for CRPS. These are still reasonable applications when the clinical picture fits, but the evidence base varies by condition.
As with any implanted device, complications can occur. Most are mechanical — a lead shifting position, a battery issue — rather than serious medical problems. The trial phase helps determine whether the therapy will work for a given patient, but it doesn’t fully predict long-term outcomes, and some patients who respond well at first may see their effectiveness diminish over time. Some patients don’t respond to DRG-S at all, even when the clinical picture is a good match.
There is also the gap between what trials describe and what any patient can actually access in real life. What you can receive depends on insurance coverage, available hardware, and the clinical judgment of your evaluating physician. The evaluation is where the evidence, your specific situation, and the practical realities all come together.
Listen to This Topic: DRG Stimulation — A Precise Answer for Pain That Lives in One Place
Prefer to listen? This Vertrae® 360 deep-dive episode explores what DRG stimulation is, who it helps, how it compares to traditional SCS, and why anatomical precision matters for nerve pain that stays in one specific area — in a two-host conversational format.
Read the Full Podcast Transcript
DISCLAIMER:
Transcript lightly edited for clarity and readability. The conversational format is designed to explore concepts and tradeoffs, not to provide medical advice or apply to any individual patient. Outcomes vary by patient, pain pattern, technology used, and study population, and findings from one clinical trial may not generalize to every situation. For guidance specific to your situation, consult a spine specialist.
TRANSCRIPT TEXT:
Speaker 1: Welcome to the deep dive. Usually when we talk about a medical diagnosis, there’s this expectation of precision. Like you break your arm, the X-ray shows that jagged white line, and the doctor points at it and says, yep, there it is.
Speaker 2: Right. It’s clean. It’s binary — broken or not broken. We inherently like things to be visible and categorized. But step into the world of chronic pain, and suddenly that X-ray machine becomes far less useful in a lot of cases. The landscape gets incredibly murky.
Speaker 1: It really does. And today we’re investigating a very specific, stubborn type of chronic pain. The kind of pain that doesn’t travel up your leg or down your arm depending on the day.
Speaker 2: Right — the kind that just stays put.
Speaker 1: Exactly. It stays in one specific, agonizing spot. So our mission today: exploring why traditional medicine often misses this localized pain, and looking at a targeted therapy designed specifically to address it.
Speaker 2: And the medical system is heavily oriented toward finding structural problems. A torn ligament, a herniated disc, a fractured bone. If it’s a mechanical failure, we generally have a scan for it.
Speaker 1: Right. We have a scan for it.
Speaker 2: But when pain becomes a processing error in the nervous system itself, patients can fall through the cracks of that structural paradigm.
Speaker 1: Which is so frustrating. So to guide us through this, we’re drawing on clinical insights and patient resources from Dr. Kamal Woods. He’s a dual fellowship-trained neurosurgeon at Vertrae® in Dayton, Ohio, and he focuses heavily on this corner of the medical world.
Speaker 1: Okay, let’s unpack this. Before we even talk about interventions, we have to describe what you, the patient, might be experiencing. The source material paints a vivid picture.
Speaker 2: Yeah, it’s not just a dull ache.
Speaker 1: We’re talking about a foot that has actually changed color after an injury. Or a hand that feels like it’s on fire if a piece of clothing brushes against it. Or a pelvic region that has burned for years after a routine hernia repair or a C-section.
Speaker 2: Right. And the frustration for these patients is often considerable. They go in, they explain that a specific patch of skin is in real distress. So the doctor orders imaging, and the results often come back unremarkable.
Speaker 1: How does that happen?
Speaker 2: That disconnect happens because doctors are trained to look for structural damage on those scans. They’re searching for that jagged white line you mentioned.
Speaker 1: But the line isn’t there.
Speaker 2: Right — because in many of these cases, the original injury, say a sprained ankle or a surgical incision, has healed. The physical tissue is intact.
Speaker 1: Okay, wait. What’s fascinating here is that the pain isn’t a symptom of a broken structure anymore. The pain processing system itself has become the focus.
Speaker 2: That’s right.
Speaker 1: Okay, I understand the distinction. But I want to push on the biology of that for a second. If the original injury healed, the scar is closed, the scan is clear — how does a single patch of skin stay in that kind of distress? What is physically happening to keep that signal alive?
Speaker 2: Great question. To answer it, we have to zoom in on the structure responsible — a cluster of nerve cells called the dorsal root ganglion, or DRG.
Speaker 1: The DRG. Okay.
Speaker 2: And the source material uses an excellent analogy. The DRG is your body’s regional mailroom for sensation. There’s one DRG at every level of your spine, on each side. And each specific DRG handles the sensory mail coming from one specific neighborhood of your body.
Speaker 1: So the DRG at one level handles signals coming from, say, your foot.
Speaker 2: Exactly. And a different DRG at another level handles the groin area. It’s highly segmented.
Speaker 1: It reminds me of an IT network.
Speaker 2: How so?
Speaker 1: Instead of all your peripheral sensory data dumping straight into the brain’s central mainframe at once, it hits an edge server first. The DRG acts as that edge server, processing and filtering the data locally before it ever touches the spinal cord or the brain.
Speaker 2: That’s actually a pretty accurate way to look at it. In a healthy system, this edge server works smoothly. You stub your toe, the foot’s DRG processes that input, sends a pain signal to the brain, and you pull your foot away.
Speaker 1: Right. Normal reaction.
Speaker 2: But when chronic localized pain sets in, the nerve cells inside that specific DRG can undergo a physical change. They upregulate their receptors. They become hypersensitive.
Speaker 1: So going back to the mailroom analogy, the local sorters become almost paranoid.
Speaker 2: Yes. They start sending out high-priority alarm letters that nobody asked for. They fire intense pain signals in response to entirely normal input — a light touch, a slight change in temperature.
Speaker 1: So if you’re listening right now, and you’ve ever winced or felt a shooting electric-shock sensation just from a bedsheet brushing your ankle at night — this can be what’s happening. Your localized edge server is stuck. Your mailroom is misfiring.
Speaker 2: Exactly. And because that specific DRG is locked in an alarm state, the pain can be quite intense, but it tends to be isolated to that one neighborhood. It often doesn’t radiate everywhere because the surrounding DRGs are still functioning normally.
Speaker 1: Okay, so naming this dysfunction has to be a huge part of the clinical process. Giving it a name makes it real.
Speaker 2: It does. The condition most associated with this stuck-DRG mechanism is complex regional pain syndrome, or CRPS.
Speaker 1: And the symptoms go well beyond a dull ache. It’s described as burning, throbbing, or electric pain. And it can cause visible physical changes.
Speaker 2: Right. The physical changes are really what set CRPS apart from standard nerve irritation. It often develops after a relatively minor injury — a broken wrist or a sprained ankle that didn’t seem terribly severe at the time. But the pain snowballs.
Speaker 1: It snowballs.
Speaker 2: Because CRPS involves the autonomic nervous system, it can affect blood flow and sweating in that region. The texts note color changes — skin turning red, blue, or mottled. Temperature differences too, where one limb may feel warmer or cooler than the other. Swelling, skin texture changes, and heightened sensitivity.
Speaker 1: So how does a clinician even diagnose this if imaging is unremarkable?
Speaker 2: Physicians often use something called the Budapest criteria. They evaluate clinical signs in four categories. They look for sensory changes like hyperalgesia — an exaggerated response to painful stimuli. They look for vasomotor changes — the temperature and skin color asymmetry we just talked about.
Speaker 1: Got it.
Speaker 2: Then they check for sudomotor changes — swelling or sweating differences. And finally, motor or trophic changes, like decreased range of motion, tremors, or changes in hair and nail growth in the affected area.
Speaker 1: Changes in hair and nail growth. That’s striking. Going through that physical examination can be the turning point. I want to share a direct quote from the source material here, because it serves as an anchor for anyone dealing with this. Dr. Kamal Woods says, “CRPS is real. It is a recognized condition, and there is an evidence-based therapy that was designed for exactly what you have. You are not imagining this.”
Speaker 2: That kind of validation can shift the entire experience for a patient. Imagine spending years being told you’re exaggerating the pain of a healed ankle sprain. Naming the condition gives patients a vocabulary for their experience.
Speaker 1: But recognizing the problem brings up the next question: if the issue is localized to one specific edge server, one DRG, how do we address it without altering the entire nervous system?
Speaker 2: That brings us to a therapy called DRG stimulation, or DRG-S. It’s an FDA-approved implantable option for CRPS of the lower limbs, and it’s used for certain other focal nerve pain conditions as well.
Speaker 1: Implantable?
Speaker 2: Yes. It uses neuromodulation to quiet that hypersensitive nerve cluster.
Speaker 1: Now I have to play devil’s advocate here. Isn’t this just a spinal cord stimulator? Those have been around for a long time, and they’re also implantable devices that use electrical signals to help with pain.
Speaker 2: It’s a common comparison, but they’re meaningfully different in their anatomical approach. Traditional spinal cord stimulation, or SCS, places thin leads just outside the spinal cord, over the dorsal columns — which act as a main pathway for sensory signals traveling to the brain.
Speaker 1: The main pathway.
Speaker 2: Right. And because SCS engages that broader pathway, it tends to affect a wider area. It’s often well-suited for more diffuse pain, like chronic back pain that radiates down both legs.
Speaker 1: Whereas DRG-S takes a different approach.
Speaker 2: Exactly. DRG-S places smaller, more specialized leads directly at the specific sorting station — the DRG itself.
Speaker 1: If we connect this to the bigger picture, it’s the difference between broadcasting a signal across an entire city, hoping to reach one specific listener, versus calling a single telephone inside one specific house.
Speaker 2: That’s a useful analogy. And we should explain how the electrical signal helps with the pain. It’s based on something called the gate control theory, combined with neuromodulation.
Speaker 1: Right.
Speaker 2: The device sends mild electrical pulses to the DRG, and those pulses essentially scramble or intercept pain signals before they reach the spinal cord. Like putting static on a specific radio frequency.
Speaker 1: So you can’t hear the song playing on that station.
Speaker 2: That’s the idea. And the targeted nature of that static creates a meaningful practical difference for patients. With traditional SCS, because it stimulates the broader dorsal column, patients often feel a tingling sensation called paresthesia.
Speaker 1: Which some people tolerate.
Speaker 2: Right. But for others, trading severe pain for a constant tingling sensation isn’t necessarily an upgrade. With DRG-S, the stimulation is often imperceptible.
Speaker 1: Really? No tingling?
Speaker 2: Often not. Many patients don’t feel a buzz. The pain simply quiets. The DRG also sits in a fairly stable spot anatomically — it’s tucked inside a bony channel called the intervertebral foramen. Because it’s physically constrained there, the distance between the stimulating lead and the nerve tends to remain consistent. Pain relief can stay steady whether the patient is sitting, standing, lying down, or bending over to tie their shoe.
Speaker 1: But that leads to a big question, because we’re talking about an implanted device. Committing to permanent hardware inside your body is a major decision.
Speaker 2: It absolutely is.
Speaker 1: How does the patient know if this neuromodulation will quiet their specific edge server before they undergo a permanent implant? What if it doesn’t help them?
Speaker 2: This is where the process is reassuring. There’s a trial phase — a five-to-seven-day testing period.
Speaker 1: So you don’t jump into permanent surgery.
Speaker 2: Correct.
Speaker 1: That’s pragmatic. You wouldn’t buy a car without test-driving it. So a test drive for a neurological implant makes sense. How does the outpatient trial actually work?
Speaker 2: Temporary, very thin leads are placed near the target DRG using a needle and advanced imaging guidance. This is done percutaneously — through the skin — typically with local anesthesia and light sedation.
Speaker 1: So the patient isn’t put under deep general anesthesia for the trial?
Speaker 2: Generally not for this part. Once the temporary leads are positioned over the DRG, they’re connected to an external generator.
Speaker 1: So the patient wears a battery pack on a belt and goes home the same day?
Speaker 2: Yes. They sleep in their own bed, they go to work, they walk around the grocery store. They track their pain and functional improvement in real-world conditions.
Speaker 1: Can they wear a normal shoe? Can they tolerate the bedsheet touching their foot at night? The clinical benchmark for a successful trial is generally a 50 percent reduction in pain.
Speaker 2: That’s the standard responder threshold used in the literature.
Speaker 1: But let’s address the alternate outcome, because people want to know — what if a patient goes through the outpatient procedure, wears the external generator for a week, and their pain only drops by 10 percent? What if it doesn’t work?
Speaker 2: If the trial doesn’t meet the threshold, it simply concludes. The temporary leads are removed in the office, similar to removing an IV. No permanent hardware was placed.
Speaker 1: Wow.
Speaker 2: It’s important to understand that an unsuccessful trial isn’t a medical failure. It’s the diagnostic system working as designed. It gives you concrete real-world evidence about whether this specific therapy fits your biology — without permanent consequences. It’s a built-in safety check.
Speaker 1: A safety net.
Speaker 1: Looking past the trial phase, we need to examine the longer-term data. A five-day trial is great, but does that translate to durable relief? Or does the nervous system find a way around the stimulation after a few months?
Speaker 2: The research on longer-term efficacy is compelling, particularly from a 2017 landmark clinical study called the ACCURATE trial.
Speaker 1: The ACCURATE trial. What did they do?
Speaker 2: It was a randomized, multicenter trial that provided a head-to-head comparison. They enrolled 152 patients with CRPS or related focal nerve injury pain in the lower limbs. Half received traditional spinal cord stimulation, and half received DRG stimulation.
Speaker 1: Head-to-head trials are pretty rare in this space.
Speaker 2: Yes. Often, newer devices are compared with medication or physical therapy. Comparing the citywide broadcast directly with the single phone call sets a high bar.
Speaker 1: It is a high bar. And the results?
Speaker 2: At three months, 81 percent of patients receiving DRG stimulation reached the 50 percent pain relief benchmark, compared with 56 percent in the traditional SCS group.
Speaker 1: That’s a notable difference.
Speaker 2: It is. And when the patients were followed out to twelve months, DRG stimulation maintained its effectiveness. The traditional SCS group showed more drop-off in relief over time, while the DRG-S patients held onto their clinical gains more consistently.
Speaker 1: So traditional SCS sometimes shows what looks like sensory tolerance over time — almost like how your body can adjust to a medication dose.
Speaker 2: Right. Because DRG-S targets the specific source of the misfire, it appears to address a more localized circuit issue, which may explain its durability in this population.
Speaker 1: And while it’s FDA-approved for the lower limbs, this targeted approach is being used for other localized pain too, right?
Speaker 2: Yes — including post-surgical nerve pain after a knee replacement, and chronic focal groin and pelvic pain after a hernia repair. Pooled analyses for groin pain have shown responder rates around 80 percent. It’s effective for the specific physiological problems it was designed to address.
Speaker 1: We have to be honest, though. A real deep dive requires looking at limitations. Who is this therapy generally not appropriate for? And what are the reasons it might fail?
Speaker 2: If a patient has widespread pain that shifts across multiple body regions — like fibromyalgia or generalized neuropathy — DRG stimulation isn’t typically the right fit.
Speaker 1: Because targeting one local edge server doesn’t help much if the entire central network is experiencing errors.
Speaker 2: Right. If the pain is primarily a deep, diffuse muscle ache, DRG-S generally isn’t the answer. And while the evidence is robust for lower-limb CRPS, the clinical data for other areas, while supportive, is drawn from smaller cohorts and is less uniform.
Speaker 1: What about failure mechanisms?
Speaker 2: It’s an implanted medical device, so physical complications can occur. The most common is lead migration.
Speaker 1: Why does the lead shift if the DRG is tucked inside that stable bony channel?
Speaker 2: Because the spine itself is mobile. Repetitive flexion and extension can pull on the wire connecting the lead to the battery. If the lead shifts even a few millimeters, the targeted electrical field can miss the nerve cluster, and the pain may return.
Speaker 1: There can also be waning efficacy over several years. What can cause the body to stop responding to the stimulation?
Speaker 2: Often it’s a biological response. The body recognizes the lead as a foreign object and forms fibrosis — scar tissue — around it. That tissue can act as an insulator, dampening the electrical pulses reaching the nerve.
Speaker 1: Wow.
Speaker 2: In other cases, neuroplasticity may find a different pathway to transmit the pain signal. And we have to acknowledge the practical hurdles of modern healthcare.
Speaker 1: Insurance.
Speaker 2: Insurance coverage, demonstrating medical necessity, and prior authorizations often shape real-world access to these implants — which makes the rigorous evaluation phase even more important. The trial isn’t only testing the hardware. It’s helping confirm that the clinical picture, the physiological evidence, and the insurance realities align before anyone commits to a permanent implant.
Speaker 1: So what does this all mean for you? If you’re listening and you have pain trapped in one specific place — pain that burns, shoots, or makes the skin difficult to touch — you deserve a careful evaluation. Not another generic medication trial, and not being told to push through it. You may benefit from a specialist who understands processing errors, not just structural fractures.
Speaker 2: Dr. Kamal Woods evaluates DRG-S candidates personally at Vertrae® in Dayton, Ohio. If the therapy is clinically appropriate, the trial and the permanent implant are performed at the Vertrae® Surgery Center in Miamisburg — a spine-exclusive outpatient facility.
Speaker 1: And that matters, because undergoing a procedure in a specialized outpatient center can mean a faster same-day discharge, in an environment focused specifically on spine care. You can explore this by visiting vertrae.com to request what they call a MotionFirst™ evaluation.
Speaker 1: We started today by looking at pain as an alarm system meant to keep us safe. But when that alarm gets stuck, the protector can become the prisoner.
Speaker 2: DRG-S is fundamentally about helping reset that stuck protective system, so patients can inhabit their bodies without constant fear.
Speaker 1: And looking at how this technology resets a localized system raises a profound question about the future of medicine. Pain evolved as our body’s ultimate protective alarm. But what happens to our sense of self when the protector becomes the prisoner?
Speaker 2: DRG stimulation isn’t just quieting an alarm. It’s helping reset a stuck protective system so people can begin to trust their own body again. And if we can isolate and modulate the exact cluster of nerves driving localized pain without altering the rest of the spinal cord — what’s stopping us from using this same hyper-targeted approach to intercept other localized nervous system misfires?
Speaker 1: Could we one day use this peripheral approach to address focal tremors? Or localized hyperhidrosis? Or even regional autoimmune flare-ups, before those aberrant signals ever reach the central brain? The potential to selectively edit the body’s sensory data is really just beginning.
Key Takeaway
DRG stimulation is a targeted therapy for chronic pain that stays in one specific area of the body. It works at a small sorting station for sensation called the dorsal root ganglion — rather than covering the broader spinal cord.
Its FDA-approved use is complex regional pain syndrome (CRPS) of the lower limbs, where the pivotal ACCURATE trial reported that 81% of patients achieved meaningful pain relief at three months versus 56% for conventional SCS. Supportive evidence has also built up for nerve pain after surgery, focal nerve injuries, and chronic groin or pelvic pain.
Like SCS, DRG-S includes a trial phase before any permanent implant — so you can test the therapy in your real life before committing.
At Vertrae® in Dayton, Ohio, Dr. Kamal Woods evaluates every patient personally — to determine whether DRG-S, SCS, ReActiv8®, or a different direction entirely is the right next step for the specific pain you are living with.
Is DRG Stimulation Right for You? Request an Evaluation at Vertrae®
Chronic pain that has lived in one specific area for months or years — and that hasn’t responded to other treatments — deserves a thorough, honest evaluation. Not another medication trial. Not another round of “manage it.” A specific answer.
At Vertrae® in Dayton, Dr. Kamal Woods evaluates every DRG-S candidate personally. When DRG-S is the right fit, all trial and implant procedures are performed at Vertrae® Surgery Center in Miamisburg — a spine-exclusive outpatient facility near Austin Landing, with same-day discharge. When DRG-S isn’t the right fit, you will get that answer honestly, along with a recommendation for what direction does make sense.
Serving: Dayton • Miamisburg • Beavercreek • Kettering • Centerville • Piqua • Cincinnati • Southwest Ohio
Vertrae® Surgery Center: Spine-exclusive outpatient facility • same-day discharge • no general hospital environment
Dr. Kamal Woods, MD, MBA: Dual fellowship-trained neurosurgeon • Cedars-Sinai trained • exclusively minimally invasive & robotic spine surgery
Frequently Asked Questions
What is the difference between DRG stimulation and spinal cord stimulation (SCS)?
Both are implantable therapies that use electrical signals to change how the nervous system processes pain. The difference is what they target. Traditional SCS works at the spinal cord level and affects a broader area. DRG stimulation targets one specific dorsal root ganglion — the sensory sorting station for one part of the body. This makes DRG-S more targeted, which is why it tends to work better for pain that lives in one specific place rather than pain spread across a larger area.
Is DRG stimulation FDA-approved?
Yes. The DRG-S system is FDA-approved for moderate-to-severe chronic intractable pain of the lower limbs in adults with complex regional pain syndrome (CRPS) Type I and Type II. It is also used for other focal nerve pain conditions — nerve pain after surgery, focal nerve injuries, and chronic groin or pelvic pain — based on clinical judgment and the supporting evidence for those uses.
How is CRPS diagnosed?
CRPS is diagnosed clinically — meaning through a careful history and physical examination, using a set of guidelines called the Budapest criteria. These look for ongoing pain disproportionate to any original injury, combined with specific findings in the affected area: extreme sensitivity, color or temperature differences, swelling, sweating differences, or changes to skin, hair, or nail growth. Imaging is generally not how CRPS is diagnosed, because standard scans often look unremarkable.
What does the DRG-S trial feel like?
During the trial, thin temporary leads are placed near the target dorsal root ganglion using imaging guidance. You are sedated and comfortable during the placement. Afterward, the leads connect to an external pulse generator worn on a belt for about a week. The stimulation itself is usually subtle — often without the tingling sensation that some traditional SCS systems produce — and many patients describe the trial as less intense than they expected. You go home the same day as the placement and live normally during the trial.
What happens if the DRG-S trial doesn’t work?
The temporary leads are simply removed in the office. No permanent hardware was placed. The trial period is designed specifically so you can test the therapy without committing to anything permanent. An unsuccessful trial is not a failure — it is a clear, real-life answer about whether DRG-S is the right therapy for your specific pain.
Is DRG-S reversible?
Yes. If the permanent system is placed and later you or your care team decide the therapy is no longer needed, the entire system — leads and battery — can be surgically removed. DRG-S does not permanently change the structure of your spine.
Does DRG-S cause a tingling sensation?
Often not. Because DRG-S targets a specific sorting station rather than the broader spinal cord, the stimulation tends to be more precise and often does not produce the tingling (paresthesia) that older SCS systems create. Some patients feel a subtle sensation; many feel nothing at all while the therapy is working. The programming can be adjusted to minimize sensation if that is a priority.
Is DRG-S covered by insurance?
DRG stimulation is typically reimbursed through Spinal Cord Stimulator coverage policies for its FDA-approved use (CRPS of the lower limbs) when medical necessity criteria are documented. Many commercial plans and Medicare cover it under those pathways, though specific coverage varies by plan and prior authorization is generally required. Coverage for other applications — nerve pain after surgery, focal nerve injuries — varies more widely and requires detailed clinical documentation. The Vertrae® team handles insurance verification and prior authorization before any procedure is scheduled.
Can DRG-S be combined with other therapies?
Yes, and in some patients it is. DRG-S can be used alongside medications, physical therapy, and other interventional treatments. In some cases, a patient who already has a spinal cord stimulator may also benefit from DRG-S targeting a specific area the SCS isn’t adequately reaching. These are individualized decisions made during the evaluation.
Is DRG-S performed at the Vertrae® Surgery Center in Miamisburg?
Yes. Dr. Kamal Woods performs DRG-S evaluations, trial procedures, and permanent implants at Vertrae® Surgery Center — our spine-exclusive outpatient facility in Miamisburg, located near Austin Landing for patients across Dayton, Southwest Ohio, Northern Kentucky, and Southeast Indiana.
Where can I see a specialist about DRG-S in Dayton, Ohio?
Dr. Kamal Woods at Vertrae® in Dayton, Ohio is a dual fellowship-trained neurosurgeon (Cedars-Sinai trained) who practices exclusively minimally invasive and robotic spine surgery. Vertrae® offers all three major neuromodulation therapies — DRG-S, spinal cord stimulation across multiple waveforms, and ReActiv8® restorative neurostimulation. Dr. Woods evaluates patients from across Southwest Ohio, Northern Kentucky, and Southeast Indiana. Visit vertrae.com to request an evaluation.
Want to Go Deeper?
This article was written for patients who want to understand DRG stimulation in plain language. If you’d like a closer look at the clinical evidence — including specific trial data, comparisons against conventional SCS, and the patient profiles where DRG-S has shown the strongest outcomes — our companion clinical pieces are available:
- Blog B1: DRG-S Foundational — clinical deep-dive
- Blog B2: DRG-S When SCS Has Failed — clinical deep-dive
About Dr. Kamal Woods & Vertrae®
Dr. Kamal Woods, MD, MBA, is a dual fellowship-trained neurosurgeon who completed combined Orthopedic and Neurosurgery Spine Fellowship training at Cedars-Sinai Medical Center. He practices exclusively minimally invasive and robotic spine surgery at Vertrae® Surgery Center in Dayton/Miamisburg, Ohio — a spine-exclusive outpatient facility offering the full range of neuromodulation therapies including DRG stimulation, spinal cord stimulation across multiple waveforms, and ReActiv8® restorative neurostimulation.
References
Deer, T. R., et al. (2017). Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and causalgia at 3 and 12 months: a randomized comparative trial. Pain, 158(4), 669–681.
Levy, R. M., et al. (2020). Dorsal root ganglion stimulation for pain caused by complex regional pain syndrome: A prospective case series with 12-month results. Neuromodulation, 23(2), 213–221.
Kretzschmar, M., et al. (2021). Three-year outcomes after dorsal root ganglion stimulation for the treatment of chronic neuropathic pain from peripheral nerve injury. Neuromodulation, 24(4), 736–745.
Huygen, F. J. P. M., et al. (2020). Effectiveness and safety of dorsal root ganglion stimulation for the treatment of chronic pain: A pooled analysis. Neuromodulation, 23(2), 213–221.
Mol, F., et al. (2023). Dorsal root ganglion stimulation for the management of chronic neuropathic pain: A systematic review and meta-analysis. Pain Physician, 26(2), E73–E85.
Harden, R. N., et al. (2022). Complex regional pain syndrome: Practical diagnostic and treatment guidelines, 5th edition. Pain Medicine, 23(S1), S1–S53.
