In a segment on Space Coast Daily Health Spotlight, Dr. Michael Esposito of Florida Pain Institute was interviewed at our Pineda clinic location, discussing DRG (Dorsal Root Ganglion) therapy. Dr. Esposito’s enthusiasm was evident when discussing the topic, which he refers to as “truly a game-changer in pain management,” as he’s seen the lives of many patients changed by the high success rate of this treatment.

Also interviewed during the segment was one of those patients who have experienced firsthand the powerful benefits of DRG therapy. The patient, Michelle Smith, had suffered injuries that led to a total knee replacement. After the surgery, she was in a great deal of pain and had tried to find relief in myriad ways, including therapy, ice, heat, rubs and epidurals, but none of these options brought the comfort she needed. As she put it, “nothing touched the pain.”

Ultimately, Michelle had a consultation with Dr. Esposito at Florida Pain Institute, and after determining that she was an appropriate candidate for the treatment, Dr. Esposito recommended DRG therapy as a solution for Michelle’s pain. The results she experienced were dramatic and nearly immediate; “Within 24 hours the change and pain relief were 99%”, she said.

So, what is DRG therapy? Here’s how Dr. Esposito explains it:

“DRG Stimulation is a type of neuromodulation that helps treat nerve pain. Other diseases and syndromes treated with DRG therapy could be peripheral neuropathy, whether it be from diabetes, severe pain from joint replacement, and pain that persists after hernia repairs. A variety of syndromes may be effectively treated with DRG.”

He goes on to explain that the Dorsal Root Ganglion is a specialized structure on each nerve as it exits the spine and travels to another location in the body, whether that be down the leg to the foot, or down the arm, etc. “What we’ve learned,” he says, “is that it’s kind of like the ‘toll booth’ on the highway; the thing that determines ‘which car shall pass’, on the nerve signal side. DRG has been implicated in chronic pain syndromes and chronic pain states. By targeting (stimulating) this structure, we’ve been able to afford patients with fantastic relief.”

The DRG stimulation process involves a small wire (lead) placed just outside the spinal cord by way of a tiny needle and sheath that are precision-guided to the epidural space, (the space outside the spinal cord but inside spinal canal,) using a real-time x-ray machine known as a fluoroscope. The lead generates electrical pulses to stimulate the DRG, which is that specialized bundle of cells responsible for ‘gating’ pain, (allowing pain to be transmitted to brain or not.) This stimulation essentially serves to block pain signals from reaching the brain.

The procedure is performed on a trial basis at first, enabling the patient to “test drive” the therapy for 7-10 days before committing the long-term version. If the trial proves that DRG therapy has effectively reduced or eliminated the pain, the lead is then anchored in place for the long term, and a battery implanted under the skin. Everything is completely self-contained, or as Dr. Esposito describes it, “set it and forget it.”

Dr. Esposito advises that DRG “Isn’t for everyone… it’s an advanced therapy often indicated for those who have failed multiple other treatments, whether that be simple injections, a variety of medications or physical therapy modalities. A trial is performed if the patient is identified as a good candidate for DRG therapy based on the type of pain they experience, how their injury occurred, etc.”

What are the most common pain conditions treated by DRG therapy?

According to Dr. Esposito, the main condition for which DRG therapy would be indicated is Complex Regional Pain Syndrome (CRPS). This is a spectrum of diseases in which patients have suffered some type of injury, whether it be to the limb, trunk, arm or leg, and they have an exaggerated response to the injury. The injury could be caused by a ‘crush’, a previous surgery or other physical trauma, and the patient’s nervous system simply overreacts to this injury.

Patients have terrible pain with CRPS, and often other associated symptoms such as numbness/tingling, severe swelling in the injured extremity, or very significant sensitivity to the limb; some patients have more severe symptoms than others, it’s a very serious and painful condition. There are also other types of pain states treated by DRG therapy, but CRPS is the most common.

In the case of Michelle Smith, DRG was exactly the treatment option she’d been looking for. Prior to the treatment, she was disabled and unable to work for 4 years, and she indicated that if she’d walked 2,000 steps per day, “it was a miracle” because she was in so much pain she couldn’t stand it.
Within 24 hours of undergoing the DRG therapy trial, she called Florida Pain Institute to request the permanent version because the relief was so immediately dramatic and significant.

Six months after permanent placement of her DRG Stimulation device, Michelle was walking 5,000 to 7,000 steps per day without pain. Smiling widely throughout the interview, she explained emotionally what the treatment has meant to her:

“DRG therapy is the best thing that could have happened to me – I have my life back. Before the treatment I was screaming from pain after standing for 10 minutes. Now I can walk, wash dishes, do laundry, and shop for groceries without riding around on the little motor cart. This has changed my life; it opened up a whole new world for me!”

Her appreciation for Dr. Esposito’s care is equally evident.

“His bedside manner is phenomenal; he treats you like you’re a human being who has feelings. He talks to you and explains everything he will do. He constantly asks if you have questions or is there anything he can explain differently to make you understand what’s available and what you can expect. Soon I’ll be moving about 1 ½ hours away from this area, but I will still make the drive to see Dr. Esposito at Florida Pain Institute!”

Dr. Esposito says that patients like Michelle are why he went into medicine in the first place. He finds it extremely fulfilling to be able to make such an impact in someone’s life, saying, “It’s why I get up in the morning and how I can sleep well at night.”

In closing, Dr. Esposito summarizes, “At Florida Pain Institute we strive to treat underlying painful conditions. It’s not just about medications, injections, or physical therapy; it’s about offering patients a multi-faceted approach to treating pain. What we know is that attacking pain from every angle is how we get the best pain relief, and DRG Stimulation is a fantastic therapy with fantastic results. There are many great studies and results to prove it. If you’re in chronic pain and you’ve tried variety of other treatments without success, this may be something that can help you.”

If you live with chronic pain, DRG therapy may be the solution you’ve been looking for.

At Florida Pain Institute, our pain management specialists are highly skilled and ready to consult with you to find a customized solution for relief from your pain. If you are one of the millions who suffer from pain, you should be aware that there are more treatment options available now than ever before.

Whether the right treatment is DRG therapy or another alternative, call us today at 321-784-8211 or request an consultation online at, and we’ll work together with you to find the most effective treatment to minimize your pain and restore your quality of life.