Comparative efficacy of closed-loop spinal cord stimulation and dorsal root ganglion stimulation through combination trialing for cancer pain - A retrospective case series.

Objective: To compare the efficacy of closed-loop spinal cord stimulation (CL-SCS) and dorsal root ganglion (DRG) stimulation in managing chronic cancer-related pain.

Material/methods: A retrospective review was conducted with IRB exemption for four patients with cancer-related pain who underwent combination stimulator trials. Patients were trialed with both CL-SCS and DRG stimulation for 8-10 days, with assessments of pain relief, functional improvement, sleep improvement, pain medication changes, and overall satisfaction.

Results: All four patients reported significant relief and functional improvement with both CL-SCS and DRG stimulations. CL-SCS provided a range of 12.9-19.6 million adjustments during the trial period. Neural dose was delivered at a median dose ratio of 1.35 and median dose accuracy of 4.9 μV. Patients 1-3 preferred CL-SCS for paresthesia-based stimulation, having the potential to expand pain coverage, full-body MRI compatibility, and real-time automated adjustment features. Patient 4 favored DRG for its ability to provide slightly greater relief, over one aspect of his pain area, despite having comparable coverage with CL-SCS.

Conclusions: The consistent and adaptable delivery of CL-SCS may bridge the gap in efficacy that DRG therapy has held over traditional dorsal column stimulation for historically complex and focal conditions that suggests further investigation.