To prepare the electrode for DRGS implantation, the insulation from the terminal portion of the larger wire was removed, and the terminal portion of the wire was folded back upon itself to produce an atraumatic tip (Figure (Figure1). The DRGS leads were manufactured from two platinum‐iridium wires of different gauges, where the larger diameter wire (0.010 in) contained the smaller center wire (0.005 in PlasticsOne, Roanoke, VA, see Figure Figure1 1 see reference ) that were secured together at one end in a plastic connection hub. Preparation electrode for DRG stimulation 18 In order to investigate the underlying pain‐relieving effect of DRGS in PDPN animals, we compared the pain‐relieving effect of DRGS vs SCS in PDPN‐associated mechanical hypersensitivity in STZ‐induced diabetic rats.Ģ.5. 18 DRGS did not cause any dorsal root ganglion (DRG) tissue damage as verified by histological examination and with the use of DRGS parameters closely replicating those in clinical use a significant reduction of mechanical hypersensitivity in chronic neuropathic animals was noted. DRGS in animals with peripheral nerve damage and chronic neuropathic pain has been described recently. 17 SCS resulted in “a clinically relevant reduction” of mechanical hypersensitivity in 70% of PDPN animals. SCS and its resulting pain relief in streptozotocin (STZ)‐induced PDPN animals have recently been described and here it was shown that SCS normalizes STZ‐induced mechanical hypersensitivity. In order to address this hypothesis, we implemented DRGS in an already operational and meticulously tested PDPN animal model and investigated the effectiveness of both DRGS and SCS. 15 As in PDPN pain is mostly present in the feet, 16 we hypothesized that DRGS is more effective in pain relief in PDPN when compared to SCS. 13, 14 The results of a recently published retrospective case series suggest that DRGS improves painful symptoms in PDPN patients. DRGS is known to achieve better pain‐paresthesia overlap of difficult‐to‐reach areas like the feet. In view of these limitations, a recently introduced and very promising option for treatment of PDPN might be conventional dorsal root ganglion stimulation. 4, 5, 6, 7, 8, 9, 10, 11, 12 However, conventional SCS often provides incomplete pain relief (50% pain reduction or even less), 10, 11 which is restricted to 60% of PDPN patients and leaves 40% of the patients as nonresponders. SCS has shown to be effective on the short and long term in PDPN when pharmacological therapies have failed. Conventional spinal cord stimulation of the dorsal columns (hereafter named SCS) has been shown to be such a treatment option, which as well can be supplementary to pharmacological therapy. 3 As PDPN can be debilitating and a severe handicap to the patient and since effectiveness of pharmacological drugs is limited, there is an urgent need for other treatment options. 1 One‐third of these DPN patients suffer from painful diabetic polyneuropathy (PDPN), 2 which starts in the toes and spreads into the feet, legs, and hands. Diabetic polyneuropathy (DPN) is a chronic, symmetric, length‐dependent sensorimotor polyneuropathy and is present in up to 50% of patients with diabetes mellitus.
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