Krames Elliot S
Pacific Pain Treatment Centers, San Francisco, California, USA.
Neuromodulation. 2015 Jan;18(1):24-32; discussion 32. doi: 10.1111/ner.12247. Epub 2014 Oct 29.
In the not-too-distant past, the dorsal root ganglion (DRG) was portrayed as a passive neural structure without involvement in the development or maintenance of chronic neuropathic pain (NP). The DRG was thought of as a structure that merely "supported" physiologic communication between the peripheral nervous system (PNS) and the central nervous system (CNS). Newer scientific information regarding the anatomic and physiologic changes that occur within the DRG as a result of environmental pressures has dispelled this concept and suggests that the DRG is an active participant in the development of NP. This new information, along with new clinical data showing that stimulation of the DRG reduces intensity of pain, suggests that the DRG can be a robust target for neuromodulation therapies.
A review of the anatomical and physiological literature regarding the role of the DRG in the development of NP was performed utilizing SciBase, PubMed, and Google Scholar. The information gathered was used to lay an anatomic and physiologic foundation for establishing the DRG as a relevant target for neuromodulation therapies and to formulate a hypothesis as to how electrical stimulation of the DRG might reverse the process and perception of NP.
The DRG is an active participant in the development of NP. DRG stimulation has multiple effects on the abnormal changes that occur within the DRG as a result of peripheral afferent fiber injury. The sum total of these stimulation effects is to stabilize and decrease hyperexcitability of DRG neurons and thereby decrease NP.
在不久之前，背根神经节（DRG）被描述为一个被动的神经结构，不参与慢性神经性疼痛（NP）的发生或维持。DRG被认为仅仅是一个“支持”外周神经系统（PNS）和中枢神经系统（CNS）之间生理通信的结构。关于DRG内因环境压力而发生的解剖学和生理学变化的最新科学信息消除了这一概念，并表明DRG是NP发生过程中的一个积极参与者。这一最新信息，连同新的临床数据表明刺激DRG可降低疼痛强度，提示DRG可能是神经调节治疗的一个有力靶点。
利用SciBase、PubMed和谷歌学术对关于DRG在NP发生中的作用的解剖学和生理学文献进行了综述。收集到的信息用于奠定将DRG确立为神经调节治疗相关靶点的解剖学和生理学基础，并就DRG的电刺激如何逆转NP的过程和感知提出一个假设。
DRG是NP发生过程中的一个积极参与者。DRG刺激对因外周传入纤维损伤而在DRG内发生的异常变化有多种作用。这些刺激作用的总和是稳定并降低DRG神经元的过度兴奋性，从而减轻NP。
