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The Effect of Clinically Controllable Factors on Neural Activation During Dorsal Root Ganglion Stimulation
dc.contributor.authorGraham, Robert D.
dc.contributor.authorBruns, Tim M.
dc.contributor.authorDuan, Bo
dc.contributor.authorLempka, Scott F.
dc.date.accessioned2021-07-01T20:08:48Z
dc.date.available2022-07-01 16:08:47en
dc.date.available2021-07-01T20:08:48Z
dc.date.issued2021-06
dc.identifier.citationGraham, Robert D.; Bruns, Tim M.; Duan, Bo; Lempka, Scott F. (2021). "The Effect of Clinically Controllable Factors on Neural Activation During Dorsal Root Ganglion Stimulation." Neuromodulation: Technology at the Neural Interface 24(4): 655-671.
dc.identifier.issn1094-7159
dc.identifier.issn1525-1403
dc.identifier.urihttps://hdl.handle.net/2027.42/168238
dc.description.abstractObjectiveDorsal root ganglion stimulation (DRGS) is an effective therapy for chronic pain, though its mechanisms of action are unknown. Currently, we do not understand how clinically controllable parameters (e.g., electrode position, stimulus pulse width) affect the direct neural response to DRGS. Therefore, the goal of this study was to utilize a computational modeling approach to characterize how varying clinically controllable parameters changed neural activation profiles during DRGS.Materials and MethodsWe coupled a finite element model of a human L5 DRG to multicompartment models of primary sensory neurons (i.e., Aα‐, Aβ‐, Aδ‐, and C‐neurons). We calculated the stimulation amplitudes necessary to elicit one or more action potentials in each neuron, and examined how neural activation profiles were affected by varying clinically controllable parameters.ResultsIn general, DRGS predominantly activated large myelinated Aα‐ and Aβ‐neurons. Shifting the electrode more than 2 mm away from the ganglion abolished most DRGS‐induced neural activation. Increasing the stimulus pulse width to 500 μs or greater increased the number of activated Aδ‐neurons, while shorter pulse widths typically only activated Aα‐ and Aβ‐neurons. Placing a cathode near a nerve root, or an anode near the ganglion body, maximized Aβ‐mechanoreceptor activation. Guarded active contact configurations did not activate more Aβ‐mechanoreceptors than conventional bipolar configurations.ConclusionsOur results suggest that DRGS applied with stimulation parameters within typical clinical ranges predominantly activates Aβ‐mechanoreceptors. In general, varying clinically controllable parameters affects the number of Aβ‐mechanoreceptors activated, although longer pulse widths can increase Aδ‐neuron activation. Our data support several Neuromodulation Appropriateness Consensus Committee guidelines on the clinical implementation of DRGS.
dc.publisherJohn Wiley & Sons, Inc.
dc.subject.otherChronic pain
dc.subject.otherspinal cord stimulation
dc.subject.othercomputer simulation
dc.subject.otherelectric stimulation
dc.subject.otherdorsal roots
dc.subject.otherdorsal root ganglion
dc.titleThe Effect of Clinically Controllable Factors on Neural Activation During Dorsal Root Ganglion Stimulation
dc.typeArticle
dc.rights.robotsIndexNoFollow
dc.subject.hlbsecondlevelNeurology and Neurosciences
dc.subject.hlbtoplevelHealth Sciences
dc.description.peerreviewedPeer Reviewed
dc.description.bitstreamurlhttp://deepblue.lib.umich.edu/bitstream/2027.42/168238/1/ner13211_am.pdf
dc.description.bitstreamurlhttp://deepblue.lib.umich.edu/bitstream/2027.42/168238/2/ner13211.pdf
dc.identifier.doi10.1111/ner.13211
dc.identifier.sourceNeuromodulation: Technology at the Neural Interface
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dc.working.doiNOen
dc.owningcollnameInterdisciplinary and Peer-Reviewed


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