The dorsal root ganglion as a therapeutic target for chronic pain

Chronic neuropathic pain is a widespread problem with negative personal and societal consequences. Despite considerable clinical neuroscience research, the goal of developing effective, reliable, and durable treatments has remained elusive. The critical role played by the dorsal root ganglion (DRG) in the induction and maintenance of chronic pain has been largely overlooked in these efforts, however. It may be that, by targeting this site, robust new options for pain management will be revealed. This review summarizes recent advances in the knowledge base for DRG-targeted treatments for neuropathic pain: Pharmacological options including the chemical targeting of voltagedependent calcium channels, transient receptor potential channels, neurotrophin production, potentiation of opioid transduction pathways, and excitatory glutamate receptors. Ablation or modulation of the DRG via continuous thermal radiofrequency and pulsed radiofrequency treatments. Implanted electrical neurostimulator technologies. Interventions involving the modification of DRG cellular function at the genetic level by using viral vectors and gene silencing methods.