{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T15:17:15Z","timestamp":1778685435475,"version":"3.51.4"},"reference-count":36,"publisher":"BMJ","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The study was financed by Swedish governmental funding of clinical research (ALF)."}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2026,5,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>subperception (paresthesia-free) dorsal root ganglion (DRG) stimulation is increasingly used for focal neuropathic pain, but sham-controlled evidence remains limited. We conducted a randomized, double-blind, sham-controlled crossover trial with enriched enrollment design in established DRG-stimulation responders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this single-center trial, adults with chronic peripheral neuropathic or nociplastic pain with implanted DRG system and sustained response (\u226550%\u2009pain reduction for \u22653\u2009months on stable stimulation settings and medication) were randomized 1:1 to active\u2192sham or sham\u2192active stimulation. Participants completed two 5-day treatment periods separated by a 24-hour washout with stimulation off. Active stimulation was delivered at 90% of the perception threshold, and sham was stimulation off. The primary outcome was median pain intensity on a 0\u201310\u2009Numeric Rating Scale (NRS). Secondary outcomes included patient satisfaction and Patient Global Impression of Change (PGIC) domains. Analyses used Wilcoxon signed-rank tests with Hodges-Lehmann estimates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In 20 randomized patients, pain intensity was lower during active than sham stimulation (median NRS 3.0 (IQR 2.0\u20134.0)\u2009vs 6.0 (IQR 4.0\u20137.0); Hodges-Lehmann median difference, \u22122.5; 95% CI \u22123.0 to \u22122.0; p&lt;0.001). Patient satisfaction and all PGIC domains favored active stimulation. Two participants terminated one treatment period early per prespecified criteria; available data were retained. No serious or device-related adverse events were reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In established DRG responders, subperception DRG stimulation produced clinically meaningful pain reduction and improved patient-reported outcomes compared with sham. These findings support efficacy during the maintenance phase of treatment, but their generalizability to unselected chronic pain populations or earlier treatment phases is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT07170722\">NCT07170722<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rapm-2026-107906","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T14:45:12Z","timestamp":1778683512000},"page":"rapm-2026-107906","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Subperception dorsal root ganglion stimulation versus sham stimulation in established responders: a randomized, double-blind crossover clinical trial"],"prefix":"10.1136","clinical-trial-number":[{"clinical-trial-number":"nct07170722","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct07170722","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2912-7059","authenticated-orcid":false,"given":"Pedram","family":"Tabatabaei","sequence":"first","affiliation":[{"name":"Department of Clinical Science, Neurosciences, Umea Universitet, Ume\u00e5, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johan","family":"W\u00e4nman","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Intervention, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amar","family":"Awad","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Neurosciences, Umea Universitet, Ume\u00e5, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Eriksson","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Neurosciences, Umea Universitet, Ume\u00e5, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josef","family":"Salomonsson","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Neurosciences, Umea Universitet, Ume\u00e5, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2029-4249","authenticated-orcid":false,"given":"Linda","family":"Bredemo","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Neurosciences, Umea Universitet, Ume\u00e5, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rickard","family":"Sj\u00f6berg","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Neurosciences, Umea Universitet, Ume\u00e5, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marwan I","family":"Hariz","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Neurosciences, Umea Universitet, Ume\u00e5, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patric","family":"Blomstedt","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, Neurosciences, Umea Universitet, Ume\u00e5, 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