Dorsal Root Ganglion and Spinal Cord Stimulation for Chronic Pain - From Mechanisms to Clinical Implementation

Session Title: Dorsal Root Ganglion and Spinal Cord Stimulation for Chronic Pain - From Mechanisms to Clinical Implementation

Topic: OTHER

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Description of Workshop: With reports of efficacy that surpass even the best pharmacological interventions for the management of pain, there has been growing interest in the mechanisms and comparative efficacy of this approach. Dr. Michael Gold will present evidence from rodent models that dorsal root ganglion (DRG) stimulation attenuates the orthodromic propagation of actional potentials to the central nervous system via the release of GABA within the ganglia. Using a voltometry-based strategy, Dr. Gold has been able to establish the stimulation parameters and kinetics of GABA release. He will also present data suggesting injury-induced suppression of GABA release within the ganglia may contribute to a loss of efficacy in some patients. Dr. Andrei Sdrulla will present his latest research on how spinal cord stimulation (SCS) engages dorsal horn circuits, using optical imaging techniques to record the activity of molecularly defined superficial dorsal horn populations in mice. Dr. Sdrulla will discuss experiments characterizing the effects of SCS on recruitment and sustained activation of excitatory and inhibitory dorsal horn circuits. The presentation will provide a theoretical framework for understanding how SCS parameter (e.g., frequency, pulse width, charge per second) non-linearly impact excitatory and inhibitory superficial dorsal horn activity. As a clinician-scientist, Dr. Sdrulla will provide the audience with translational implications of these findings. Dr. Lisa Goudman will synthesize the clinical evidence situating DRGS and SCS within the broader treatment landscape. She will highlight network meta-analyses comparing neuromodulation with pharmacologic, interventional, and conservative therapies, and integrate real-world outcomes on durability, safety, and explant/revision rates. Dr. Goudman will also address disparities in access to neuromodulation across socioeconomic and geographic contexts, examining reimbursement and system-level barriers. Collectively, these data will inform patient selection, guideline development, and policy decisions to support equitable, evidence-based use of neuromodulation.

Speakers