Dorsal Root Ganglion (DRG) Stimulation for Focal Nerve Pain

The Basics

What Is DRG Stimulation?

The dorsal root ganglion (DRG) is a small cluster of sensory nerve cell bodies that sits just outside the spinal cord, where the nerves from one specific region of the body gather before entering the spine. It works like a junction box for sensation. A thin lead placed next to a chosen DRG delivers gentle electrical pulses that quiet the pain signals from exactly that region — and little else.

01

Pinpoint Target

Because each DRG serves a specific patch of the body, stimulation can be focused on an area as small as one foot or knee — without covering places that do not hurt.

02

Trial First

Like spinal cord stimulation, DRG stimulation is tested with a temporary trial before any permanent device is placed, so you feel the relief before committing.

03

Position-Stable

The DRG sits in a space with very little cushioning fluid, so the stimulation stays steady whether you are lying down, sitting, or standing — with far less of the surging that can affect SCS.

Interactive Tool

DRG vs SCS: Targeting & Position

Both therapies quiet pain by interrupting nerve signals, but they aim differently. Switch between them below to see where each one places its lead, how precisely it covers a focal pain area, and how the stimulation holds up when you change position.

Interactive · Compare the two

Where the lead sits — and how the coverage behaves

The pain here is focal: it lives in one foot (shown in red). Choose a therapy, then switch your body position between lying, sitting, and standing. Watch two things: how well the stimulation matches the painful spot, and whether the strength of the sensation stays steady as you move.

Targeting

Select a therapy

Coverage match to the focal pain

—

Sensation strength as you change position

Green band = comfortable range

Pick DRG or SCS to begin.

Your body position

Best forSelect a therapy above to see which pain patterns it suits best.

This is a simplified, educational illustration of how the two therapies target pain and respond to position. It is not a measurement of your own pain or a prediction of your result.

Side by Side

How DRG Differs From SCS

DRG stimulation grew out of spinal cord stimulation and shares its logic: a trial, then an implanted, reversible, programmable device. The differences are about where it aims and how that aim behaves.

	DRG Stimulation	Spinal Cord Stimulation (SCS)
Where the lead sits	Next to a specific dorsal root ganglion, near where one nerve root exits the spine	In the epidural space over the back of the spinal cord (dorsal column)
Coverage	Focused on the one body region that DRG serves — foot, knee, groin	Broad bands, best for larger areas like the whole leg or lower back
Effect of body position	Very stable — little cushioning fluid around the DRG, so intensity changes little	More position-sensitive — sensation can surge or fade as you move
Best-fit pain	Focal neuropathic pain, complex regional pain syndrome (CRPS), causalgia of the lower limb	Broader neuropathic pain, persistent leg/back pain after spine surgery
Shared with SCS	A temporary trial before implant · reversible · programmable · no permanent change to the spine

Candidacy

Am I a Candidate?

DRG stimulation is FDA-approved for complex regional pain syndrome (CRPS) and causalgia of the lower limbs, and it is especially useful when pain is confined to a focal area that SCS struggles to cover. As with SCS, the trial is itself the best test of candidacy.

Good Candidate

Focal neuropathic pain concentrated in one region — foot, knee, ankle, or groin
Complex regional pain syndrome (CRPS) or causalgia of the lower limb
Persistent nerve pain after a surgery or injury in one area (for example, after knee or hernia surgery)
Pain that has not responded to medications, injections, or physical therapy
A clear psychological evaluation and no active infection or bleeding disorder
Realistic expectations: DRG reduces pain, it rarely eliminates it

Less Ideal

Widespread pain over large areas (broad SCS coverage may fit better)
Predominant mechanical, axial back pain rather than nerve pain
Untreated psychiatric conditions
Active infection, or not a suitable candidate for the implant procedure overall
Certain implanted devices or anatomy that make lead placement difficult (a case-by-case consideration)

The Path

Trial First, Then Implant

This is the same reassuring two-step path as spinal cord stimulation: you get to try the therapy before you commit. A short trial predicts whether a permanent implant will help.

Step 1

Consultation & Mapping

A detailed pain history and exam to confirm the pain is focal and neuropathic, identify which DRG serves the painful area, and complete a psychological evaluation.

Step 2

Trial Procedure

An outpatient procedure. One or more temporary leads are guided to the target DRG through a needle under live X-ray (fluoroscopy), with no incision.

Step 3

5 to 7 Day Trial

You go home with an external stimulator and test real relief during your normal activities, paying attention to whether the focal pain quiets down.

Step 4

Permanent Implant

If the trial gives meaningful relief (generally at least 50%) and better function, the permanent leads and battery (IPG) are placed as an outpatient.

Results

What Outcomes Can Patients Expect?

The pivotal ACCURATE trial compared DRG stimulation head-to-head against SCS in 152 people with CRPS or causalgia of the lower limbs. It is the main reason DRG became an option for focal lower-limb pain.

81% vs 56%

Treatment Success at 3 Months

In ACCURATE, 81.2% of DRG patients reached the success threshold (at least 50% pain relief, no stimulation-related neurological deficit) versus 55.7% with SCS.

74% vs 53%

Still Successful at 12 Months

At one year, 74.2% of DRG patients maintained treatment success versus 53.0% with SCS — DRG met both non-inferiority and superiority.

Steadier

Less Position-Dependent

DRG patients reported significantly less change in the strength of the stimulation sensation between lying down and standing than SCS patients.

Risks and Honest Trade-offs

DRG stimulation is generally low-risk, but no procedure is risk-free, and most issues relate to the hardware. Because the leads sit in a tighter, more mobile space than SCS leads, lead migration or fracture is a recognized problem and is one of the more common reasons a device needs a revision procedure. Other risks include infection, bleeding, pain at the battery pocket, and, uncommonly, a small tear in the lining around the nerves (dural puncture) causing a headache. As with any neurostimulator, some patients ultimately have the device removed (explant) if it stops helping — which is exactly what the trial is designed to reveal before a permanent implant.

DRG is a pain-management therapy, not a cure: the realistic goal is a meaningful, durable reduction in the focal pain and better daily function. Your team will also counsel you about MRI compatibility and interactions with other implanted devices. Because the trial is reversible and low-commitment, it lets you weigh real benefit against these trade-offs before deciding.

Frequently Asked Questions

Common Questions

How is DRG stimulation different from spinal cord stimulation?

Both are implanted, reversible, programmable devices that quiet nerve pain, and both start with a trial. The difference is targeting. SCS places a lead over the back of the spinal cord and covers broad areas, which works well for larger regions like the whole leg. DRG places a lead right next to the dorsal root ganglion that serves one specific area, so it can focus on a small, hard-to-reach spot — the top of a foot, a knee, the groin — without stimulating everywhere else. DRG stimulation is also steadier when you change position. You can see both behaviors in the DRG vs SCS comparator above.

What is the dorsal root ganglion?

It is a small cluster of sensory nerve cell bodies that sits just outside the spinal cord, at the point where the nerves from one region of the body gather before entering the spine. Think of it as a junction box for sensation from a specific area. Because each DRG maps to a defined patch of the body, placing a lead beside it lets stimulation be aimed very precisely.

What kind of pain does DRG stimulation help most?

It is best for focal neuropathic (nerve-related) pain concentrated in one area, and it is FDA-approved for complex regional pain syndrome (CRPS) and causalgia of the lower limbs. Common targets include pain in the foot, knee, ankle, or groin, including persistent pain after a surgery or injury in that region. Widespread pain over large areas is usually a better match for traditional SCS.

Why does position matter less with DRG?

Traditional spinal cord stimulation leads sit in the epidural space where the amount of cushioning spinal fluid changes as you move, so the strength of the sensation can surge when you lie down or fade when you stand. The dorsal root ganglion sits in a location with very little of that fluid, so the distance between the lead and the nerve barely changes with position. In the ACCURATE trial, DRG patients reported much less change in stimulation intensity between lying and standing than SCS patients.

What happens during the trial?

The trial is a short, outpatient test. One or more thin temporary leads are guided to the target DRG through a needle under live X-ray, without any incision, and connected to an external stimulator you wear. You go home and live normally for about 5 to 7 days, noting whether your focal pain quiets down. At the end the temporary leads are simply removed. If the trial helped meaningfully, you can proceed to a permanent implant; if not, nothing permanent was placed.

Does DRG stimulation cure my pain?

No. Like SCS, DRG stimulation is a therapy to manage pain, not a cure for its underlying cause. The realistic goal is a meaningful, lasting reduction in the focal pain and an improvement in what you can do day to day. Many patients also reduce their pain medications. Setting this expectation up front is part of a good outcome.

What if it stops helping later?

Because DRG stimulation is programmable and reversible, a lot can be done. The stimulation can be reprogrammed as your pain changes, a shifted lead can sometimes be revised, and if the therapy no longer helps, the device can be turned off or removed. You are not locked in.

Our Team

Who We Are

This educational resource was developed by Brown Neurosurgery to help patients and families understand dorsal root ganglion stimulation for focal nerve pain. Our neuromodulation team works alongside pain management, physiatry, and psychology to make sure DRG or SCS is offered to the right patients, and to support you through the trial, implant, and long-term programming.