DRG Stimulator Alleviates Chronic Knee Pain

Implanted device brings “100%” relief after failed joint replacements.

When Seattle native Samuel Knox was in the Navy in the early 1980s, he had plenty of time to consider his future. He liked computers, so he chose to pursue a career in information technology. Upon his discharge from the service, Samuel returned to school and earned a degree in that field and has been working in IT ever since.

“Boeing is a major company in the Seattle area. I applied there and got a job as a network engineer. I worked for Boeing for 25 years,” shares Samuel, 60. “Two years ago, an opportunity arose to move to Florida and work for L3Harris. They were willing to relocate me and my family to Melbourne, so I retired from Boeing and went to work for L3Harris, where I still work as a network engineer.”

Like Boeing, L3Harris is a global aerospace and defense technology company.

“Every company has an internal network. All employees and administrators who use computers to communicate, do research and surf the web need a network to do those things,” Samuel informs. “Being a network engineer involves designing, deploying and troubleshooting the network infrastructure.”

While Samuel effectively maintains his employer’s network infrastructure, a weakness in his body’s infrastructure has resulted in pain and disability. Samuel cannot recall an initiating injury, but he was a long-distance runner when he was younger, which may have contributed to the degeneration of his left knee.

“My knee problems began in 2004. I experienced severe pain in my knee after doing not much of anything,” Samuel confirms. “It would swell up for two to three weeks, and then the swelling would go away until something else caused it to flare up again. It turned out I had arthritis in my knee.

“At different times, the pain was sharp, stabbing and aching. Usually, it was between a six and eight on a scale of one to 10. The pain significantly affected my ability to perform activities such as yardwork and chores around the house. It hurt when I walked, which forced me to walk with a limp.”

X-rays showed the joint was bone-on-bone. For that reason, Samuel agreed to undergo a knee replacement.

“The surgery was done in December 2013, but it was not successful,” Samuel reveals. “I gave my new knee a whole year to mend, then went back to the doctor to see what could be done. The doctor determined that my joint was too loose, so he replaced the knee a second time in December 2014.”

That corrected the mechanical problem but didn’t resolve Samuel’s pain. He visited a pain management specialist, who determined Samuel had permanent nerve damage.

“The doctor prescribed an opioid to manage the pain,” Samuel relates. “The medication helped some, but I wasn’t happy that I had to take such a dangerous drug.”

Once in Florida, Samuel visited several physicians seeking an answer to his ongoing pain, including another pain management specialist and an orthopedic surgeon. But it was a dermatologist who recommended Samuel visit Michael F. Esposito, MD, a board-certified anesthesiologist and pain management specialist at Interventional Spine & Pain Institute in Vero Beach.

Pacemaker for Pain

Dr. Esposito determined that Samuel was experiencing a type of chronic postsurgical pain, which is referred to clinically as causalgia or complex regional pain syndrome type II (CRPS II). To treat the condition, Dr. Esposito recommended dorsal root ganglion (DRG) stimulation.

“There are many patients who undergo knee or hip replacement, foot and ankle surgery or hernia repair surgery and end up with persistent pain,” the doctor contends. “Most of these patients are underserved by traditional pain management.

“These patients are excellent candidates for DRG stimulation, a treatment that has proved to be superior at providing knee pain relief compared to other traditional types of spinal cord stimulation.”

A dorsal root ganglion is a collection of nerve cell bodies in the dorsal root (back portion) of a spinal nerve. It is located where the nerve exits the spinal canal, at the intervertebral foramina. There are multiple DRGs up and down the spine. Each is responsible for the transmission of pain and other sensations from specific parts of the body.

“A DRG stimulator is like a pacemaker for pain. It has two main parts: the leads and the battery,” Dr. Esposito describes. “We place the leads next to the DRG responsible for the pain. For chronic knee pain, we typically target the DRGs of the lumbar L3 and L4 spinal nerves.”

“The device’s leads are connected to a power source, or battery, which is eventually implanted under the skin, usually in the buttock or flank,” Dr. Esposito continues. “The DRG stimulator stimulates the nerves carrying the pain signals, blocking the signals from reaching the brain and filtering out the pain.

“The DRG stimulator allows us to target the painful areas without affecting extraneous areas. It does not replace the pain with a substitute sensation such as tingling. It simply turns down the volume on the pain.”

Before implanting the DRG stimulator, Dr. Esposito performed a weeklong trial to determine the effectiveness of the treatment on Samuel’s knee pain. The trial allowed Dr. Esposito to identify and precisely target the area generating the pain.

“Mr. Knox reported 100 percent pain relief and improved function from the trial, so we proceeded to implant the stimulator for long-term use,” the doctor reveals. “We already had an idea of where to place the leads based on Mr. Knox’s pain description. The trial just confirmed it.”

“I Have Zero Pain”

Samuel received his permanent DRG stimulator on September 1. He immediately experienced the same results he achieved with the trial.

“I am 100 percent pain-free,” he enthuses. “I have zero pain, and I’m fully functional again. I’m actually more active now because I can walk and get out and exercise. I can also take care of the yard and house. And it’s a new house, so there’s lots to do.”

“I’m 100 percent pain-free. I have zero pain, and I’m fully functional again.” – Samuel

Samuel is equally pleased with the pain management specialist who recommended DRG stimulation as well as the provider’s staff.

“Dr. Esposito is very knowledgeable and easygoing, very easy to talk to,” Samuel raves. “He took his time to explain everything. I never felt like I was being rushed into anything. Working with Dr. Esposito and his staff has been outstanding, one of the best experiences I’ve ever had with a doctor’s office.

“I recommend DRG stimulation and Interventional Spine & Pain Institute hands down.”

© FHCN article by Patti DiPanfilo. mkb
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