Dorsal root ganglion stimulation provides functional improvement from debilitating abdominal pain in Crohn's disease: A 12-month follow-up

Abstract

Background: Crohn's disease (CD) is a chronic relapsing-remitting, immunological, inflammatory bowel disease involving any part of the gastrointestinal tract, most commonly, the terminal ileum. Abdominal pain is a prominent debilitating symptom of CD due to continuous intestinal inflammation, associated with disease severity and complications. However, abdominal pain has shown to occur even with disease remission.

Case presentation: A female college student with a history of Crohn's Disease was referred for severe, chronic abdominal pain, with frequent flare-ups and hospitalizations. Due to her refractory debilitating pain, DRG stimulation was initiated with leads placed at right T11 and T12. Twelve months post-implantation, the patient reports 50-60 % reduction in pain, tolerance of an oral diet without postprandial pain, no occurrence of flares since implant, and an overall improvement in function and quality of life.

Conclusion: This report showcases the therapeutic potential of DRG stimulation in managing intractable chronic abdominal pain in inflammatory bowel diseases such as Crohn's disease.

Keywords: Chronic abdominal pain; Crohn's disease; DRG; Inflammatory bowel disease; Neuromodulation.

Fig. 1

Fluoroscopic images demonstrating right T10 and T12 DRGS trial leads placement.

Fig. 2

Fluoroscopic image demonstrating right T10 and T12 DRGS permanent lead placement.

Fig. 3

Patient reported pain rating pre-implantation and post-implantation at two weeks, one month and one year intervals∗. ∗ The spacing between the data points on this graph does not correspond to the actual time intervals between them as the graph is not scaled proportionally.