Bibliometrics of dorsal root ganglion stimulation

Clustered themes and topic trends of dorsal root ganglion stimulation: a

text-mining study with latent Dirichlet allocation

Guoxin Fan1,2,3,#, Chaobo Feng4,5,#, Zhipeng Xu1,#, Qingtian Luo1,2, Zhouyang Hu1,2, Shisheng
He4,5,*, Xiang Liao1,*

1
Department of Pain Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital,
Shenzhen, China.
2
Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical
Engineering, School of Medicine, Shenzhen University, Shenzhen, China.
3
Department of Spine Surgery, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
4
Spinal Pain Research Institute, School of Medicine, Tongji University, Shanghai, China.
5
Department of Orthopedics, Shanghai Tenth People's Hospital, School of Medicine, Tongji University,
Shanghai, China.

#
These authors have contributed equally to this work.

* Corresponding authors’ information:

Shisheng He; mail addresses: tjhss7418@tongji.edu.cn;
Xiang Liao; Email addresses: liaoxiang75@email.szu.edu.cn

Abstract
Background: Dorsal root ganglion stimulation (DRGS) is an emerging minimally invasive
spinal surgical technique to manage chronic pain in recent years. Therefore, the purpose of
this study is to summarize the main themes and analyze the research trends of DRGS with text
mining.
Material and Methods: The DRGS-related articles were obtained from the Web of Science
Core Collection. All documents’ text information, including title, author, journal, keywords,
citations, etc., was imported into bibliometric analysis and visualized by R language. Latent
Dirichlet allocation (LDA) was used to summarize the main themes of the field.
Results: A total of 3449 articles were included in this study. NEUROSCIENCE was the most
productive journal (170 articles) and JOURNAL OF NEUROSCIENCE was the most impact
journal (H-index: 75). The United States has an unquestionable influence in DRGS in terms of
the number of articles, total citations, collaborations and the number of productive affiliations.
Four main themes were summarized, including functional experiment (1014, 29.40%),
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 Bibliometrics of dorsal root ganglion stimulation

molecular mechanism (921, 26.70%), nerve regeneration (817, 23.69%) and clinical
application (674, 19.54%) of DRGS. The clinical application of DRGS was the dominant
themes in the recent 5 years. The research evolution presented a gradual shift of research
focus from basic research to clinical application, indicating the successful translation of
DRGS from bench to bedside.
Conclusion: The intensification of enthusiasm for this field has increased. The current topics
concentrated on clinical application of DRGS, and the future trend may be the clinical
application of DRGS in some particular diseases except for modulating chronic pain.
Keywords: Dorsal root ganglion stimulation; dorsal root ganglion; latent Dirichlet allocation;
chronic pain; Bibliometrics

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 Bibliometrics of dorsal root ganglion stimulation

Introduction
The dorsal root ganglion (DRG), located in the intervertebral foramina on both sides of
each spinal segment, is responsible for translating and transmitting peripheral sensory
information to the the central nervous system (CNS) [1]. The DRG contains all somas of the
primary sensory neurons[2] without protective blood-brain barriers like CNS, but it is
protected by surrounding bony structures [3]. Given its unique anatomical location and
physiological function, the DRG is considered an important neurostimulation target to
manage chronic pain, like failed back surgery syndrome (FBSS), complex regional pain
syndrome (CRPS), post-joint surgery pain, ect.
Chronic pain, mainly including nociceptive pain, neuropathic pain and mixed pain, is
one of the most prevalent and disabling health problems worldwide[4]. DRG stimulation
(DRGS), an emerging minimally invasive spinal surgical technique to manage chronic pain,
has been approved by Food and Drug Administration in many countries like USA and
European countries[5, 6]. Studies where the DRGS has been available have shown that a
≥50% pain relief rate can be 80-100% at 3 months [7, 8] and 60-80% at 12 months[9, 10].
Furthermore, compared with drugs or radiofrequency treatment, the DRGS is safer, more
effective, and more enduring[11, 12]. In contrast to traditional spinal cord stimulation (SCS),
the DRGS requires less energy[13], has higher specificity[7], fewer influencing factors[14],
and is safer[15] and more stable, especially in focal pain. Therefore, a timely scientometric
summary and quantitative analysis of the DRGS is necessary.
Bibliometrics is a reproducible, objective, and reliable informatics method to analyze
publications. Through quantitative analysis of published articles, bibliometrics visualizes the
development paths, main themes, and topic trends of the given field. Bibliometrics has been
used extensively in pain of various etiologies, such as post-stroke pain[16], diabetic peripheral
neuropathic pain[17] and postsurgical pain[18], and in treatments such as analgesics[19],
percutaneous electrical nerve stimulation[20], and transcranial magnetic stimulation[21]. As a
powerful bibliometric tool, Latent Dirichlet allocation (LDA) is adopted to summarize the
research themes by more and more studies[22, 23]. However, to our knowledge, there has
been a dearth of bibliometrics in DRGS. The purpose of this study is to summarize the
research evolution of DRGS by LDA and present the possible trends for future research.
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 Bibliometrics of dorsal root ganglion stimulation

Materials and Methods

Data Acquisition
As all the data were directly extracted from the public database, ethical approval was
waived by the local ethical committee. The included literature was obtained from the Web of
Science Core Collection (WoSCC) database. The search was limited to the topics "dorsal root
gangli*" and "stimulat*", from 1979 to 2022 with no language restrictions. All documents’
information (including title, author, journal, keywords, country of origin, citations, etc.) was
saved in BibTeX format and imported into Rstudio 1.3.1 for subsequent analysis. All the
above operations were performed on Apr 25th, 2023, to minimize bias. Publication records
were excluded if the publication year was in 2023 or article type was not article (Figure 1).

Figure 1. Screening flowchart of included publications concerning DRGS.

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 Bibliometrics of dorsal root ganglion stimulation

Bibliometric analysis
The bibliometric analysis was performed using Biblioshiny (RStudio, 1.3.1). The
software was used to summarize and describe the basic information of the dataset, the number
of articles, citations, and other information. The authors' contributions and impact on the field
were assessed based on the number of papers, collaborations, and H-index. For the journals,
we counted the publication productivity and the H-index to evaluate the impact. To compare
the contribution and impact of the institution and country/regions, the publication numbers
and citations were used. Local citation score (LCS) and global citation score (GCS) were also
included to identify important articles in the field.
The main themes of DRGS were classified using LDA model, which takes each
document as a patch of unordered words. As an unsupervised machine learning algorithm,
LDA contains a three-layer Bayesian probabilistic structure of words, topics and documents
and aims to summarize each theme as a probability distribution across words based on the co-
occurrences of words. Words in the abstracts of included documents were imported into LDA
analysis, which was conducted by R package “lda”. The number of themes in the field of
DRGS was set to at least four. Additionally, using author keywords in the included documents,
thematic map was also used to classify the main themes of DRGS. The raw data was available
in the Dataset S1.

Results
General Information
As of 2022, a total of 3449 articles were included in WoSCC. The annual scientific
production in the field of dorsal root ganglion stimulation had shown a significant increasing
trend since 1990 with an annual growth rate of 10.61%. There were 710 sources in the dataset,
and the average citations per document were 40.92 (Table S1). The annual number of
published articles showed a roughly upward trend and a large increase in the three years from
2019 to 2021. In 2021, the number of articles reached an all-time peak of over 150 but fell
back in 2022 (Figure 2). The production and citation trend of the top 20 productive authors
and the collaboration network of different authors in DRGS were shown in Figure 3. The size
of the blue bubbles in Figure 3A represented the number of articles, while darker color
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 Bibliometrics of dorsal root ganglion stimulation

indicated higher total citation per year. The connecting line between authors indicated the
collaboration and the thickness of the line was proportional to the collaboration (Figure 3B).
By observation, it was found that most publications of the top productive authors were
published in the recent 5 years, and the top productive scholars maintained active
collaborations.

Figure 2. Annual scientific production over time in DRGS.

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 Bibliometrics of dorsal root ganglion stimulation

Figure 3. Analysis of authors in DRGS. A: Top 20 productive authors in DRGS over time. N.
articles, number of articles; TC per year, total citations per year. B: Collaboration network of
different authors in DRGS.

Analysis of journals
The top 10 journals in terms of the number of articles and impact in DRGS research were
listed in Table 1. Journals in the top 10 rankings accounted for 29.6% (1020/3449) of total
publications. NEUROSCIENCE was the most productive journal (170 articles) with the
fourth H-index (46) and the second total citations (6583) in this field. Following, JOURNAL
OF NEUROSCIENCE (143 articles) and PAIN (135 articles) did not differ significantly in
terms of production, and both of them belong to top 3 impact journals either in terms of H-
index or total citations. JOURNAL OF NEUROPHYSIOLOGY was the fourth productive
journal (99 articles), and also ranked third or fourth with respect to H-index or total citations.
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Among the top 10 productive journals, nine of ten belong to the specialized area of
neuroscience and pain. Among the top 10 impact journals ranked by H-index, seven of ten
belong to the specialized area of neuroscience and pain. Among the top 10 impact journals
ranked by total citations, eight of ten belong to the specialized area of neuroscience and pain.

Table 1. Top 10 productive and impact journals in DRGS.

Ranking Journals ranked by articles Articles Journals ranked by H- H- Journals ranked by TC*
index index TC
1 NEUROSCIENCE 170 J. NEUROSCI. 75 J. NEUROSCI. 15991
2 J. NEUROSCI. 143 PAIN 54 PAIN 7947
3 PAIN 135 J. NEUROPHYSIOL 46 NEUROSCIENCE 6583
4 J. NEUROPHYSIOL 99 NEUROSCIENCE 46 J.
NEUROPHYSIOL 5804
5 NEUROSCI. LETT. 96 EUR. J. NEUROSCI. 36 J. PHYSIOL-
LONDON 4550
6 BRAIN RES. 89 BRAIN RES. 33 PROC. NATL.
ACAD. SCI. U.S.A. 4175
7 NEUROMODULATION 87 J. PHYSIOL-33
LONDON NEUROSCI. LETT. 3365
8 MOL. PAIN 80 PROC. NATL. ACAD.33 EUR. J.
SCI. U.S.A. NEUROSCI. 3260
9 EUR. J. NEUROSCI. 62 J. BIOL. CHEM. 30 EXPERIMENTAL
NEUROLOGY 3222
10 J. PHYSIOL-LONDON 59 NEUROSCI. LETT. 30 BRAIN RES. 3191
*TC, total citations.

Analysis of countries/regions and affiliations

Table 2 listed the top 20 most productive and impact countries/regions. The articles from
the top 20 countries/regions (3229) comprised 93.6% of all 3449 publications. The United
States undoubtedly ranked first with 1131 articles and was far ahead of China (494 articles)
and Japan (326 articles). It was noted that most countries/regions of the top 20 productive list
belonged to developed entities (17/20), and Taiwan, one of the most developed regions, was
also in the list. The impact of different countries/regions was demonstrated by the total
citations and the average article citations. Again, the US had the highest total citations in the
DRGS, far ahead of other countries, which was followed by the United Kingdom, Japan,
Germany, and China respectively. However, when considering the average article citations,
Finland jumped to first place, while the US dropped to tenth and China was even not in the
top 20 impact list.

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Table 2. The most productive and impact countries/regions in the DRGS.

Ranking Country/Region Articles Country/Region TC* Country/Region AAC*
ranked by articles ranked by TC ranked by AAC
1 USA 1131 USA 57618 FINLAND 179.60
2 CHINA 494 UNITED 12708
KINGDOM LEBANON 91.00
3 JAPAN 326 JAPAN 9986 ISRAEL 67.00
4 UNITED 251 GERMANY 9197
KINGDOM FRANCE 65.12
5 GERMANY 235 CHINA 7644 UNITED
KINGDOM 55.14
6 CANADA 133 CANADA 5893 SWEDEN 53.12
7 KOREA 97 SWEDEN 4882 ITALY 53.10
8 SWEDEN 96 ITALY 4347 AUSTRALIA 52.41
9 ITALY 78 FRANCE 3901 BELGIUM 51.87
10 FRANCE 74 AUSTRALIA 2980 USA 49.25
11 AUSTRALIA 67 ISRAEL 2521 CANADA 48.36
12 TAIWAN 61 KOREA 1950 DENMARK 43.25
13 NETHERLANDS 51 SPAIN 1353 AUSTRIA 41.71
14 SPAIN 43 AUSTRIA 1330 GERMANY 39.16
15 BRAZIL 40 NETHERLANDS 1212 ROMANIA 34.29
16 ISRAEL 36 SWITZERLAND 1163 HUNGARY 34.10
17 SWITZERLAND 36 BELGIUM 1123 CHILE 33.67
18 AUSTRIA 33 BRAZIL 888 SPAIN 33.57
19 TURKEY 28 TURKEY 621 SWITZERLAND 33.44
20 BELGIUM 25 DENMARK 523 LITHUANIA 32.75
*TC, total citations; AAC, average article citations.

The collaboration network of different countries/regions in DRGS was shown in Figure

4A which vividly showcased the collaborative relationships among various countries/regions.
This visualization figure effectively provided insights into their collaborative relationships by
representing the intensity of collaborations with the number and varying width of the blue
interconnecting lines. The United States engaged in the most frequent cooperation with other
countries, particularly those in Europe, but it collaborated the most frequently with China.
Additionally, China, Japan, Germany, the United Kingdom, and Canada were among the
leading countries in terms of the frequency of their international collaborations.

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Figure 4: Collaboration network of different entities. A: Collaboration network of different

countries/regions in DRGS. B: Collaboration network of different affiliations.

The top 10 productive affiliations were shown in Table 3. The top 3 were the University
of Pittsburgh (184 articles), the University of California San Francisco (159 articles), and the
University of Michigan (120 articles). Meanwhile, it was worth noting that seven out of the
top ten affiliations were located in the United States and the University of Pittsburgh had
made significant contributions in this field, with a significantly higher publication production
than any other institution. In Figure 4B, a collaboration network among various affiliations
had been constructed. Frequently collaborating affiliations were assigned the same color and
connected by lines, with the width of the line reflecting the frequency of scientific
collaboration.
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 Bibliometrics of dorsal root ganglion stimulation

Table 3. Top 10 productive affiliations in DRGS.

Ranking Affiliation Articles Country
1 UNIV PITTSBURGH 184 The United States
2 UNIV CALIF SAN FRANCISCO 159 The United States
3 UNIV MICHIGAN 120 The United States
4 UNIV TEXAS 118 The United States
5 MCGILL UNIV 117 Canada
6 UNIV CALIF LOS ANGELES 105 The United States
7 JOHNS HOPKINS UNIV 89 The United States
8 KAROLINSKA INST 85 Sweden
9 UNIV ERLANGEN NURNBERG 82 German
10 MED COLL WISCONSIN 77 The United States

Theme analysis
Using abstract content, LDA clustered DRGS-related researches into four main themes,
among which three were associated with basic experiments and one belong to clinical
application (Figure 5). The productivity of the four themes were 1014(Theme 1: 29.40%),
921(Theme 2: 26.70%), 817(Theme 3: 23.69%), and 674 (Theme 4: 19.54%), respectively. It
seemed that nearly one third of publications were basic researches concerning the functional
experiment of DRGS (Theme 1), followed by Theme 2 concerning the molecular mechanism
of DRGS. Similarly, nearly a quarter of publications were basic researches concerning the
nerve regeneration of DRGS (Theme 3), followed by Theme 4 concerning clinical application
of DRGS. While presenting the evolution of the four main themes over time (Figure 6A),
Theme 1 kept as the most productive theme for two decades (1990 to 2010). After 2000,
publications belong to Theme 2 gradually became the second or the first productive theme in
most years. Conversely, publications belong to Theme 3 failed to keep as the second
productive theme after 2000, and stayed as the third productive theme for another two
decades. Interestingly, Theme 4 presented a skyrocket growth in the productivity after 2010,
and then became a dominant theme in the recent 5 years.

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Figure 5. Main themes of DRGS-related researches clustered by LDA.

Using author keywords in the documents, the thematic map also summarized four main
themes in the field of DRGS (Figure 6B). The upper right quadrant of the thematic map
focuses on motor themes, which are significant to the research field and well-developed. The
niche themes are less significant to the research field located in the top left quadrant although
they are both well developed. The themes in the lower left quadrant are either emerging or
disappearing themes, and basic themes are usually the foundational findings to generate the
field. By interpreting the keywords in the four quadrants of the thematic map, the motor
themes in this field were closely related to the molecular mechanism of DRGS (corresponding
to Theme 2). The niche themes in this field were associated with the nerve regeneration of
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DRGS (corresponding to Theme 3). The basic themes were associated with the functional
experiment of DRGS (corresponding to Theme 1). The emerging or declining themes seemed
to be the clinical application of DRGS (corresponding to Theme 4). Therefore, it seemed that
theme clustering of DRGS was consistent either using abstract text or author keywords.

Figure 6. Theme analysis of DRGS. A: Theme evolution over time; B: thematic map
analysis.
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Trend topics and most-cited articles

Using author’s keywords in the included documents, term frequency was present to
summarize the trend topics of DRGS in the past 20 years. The word minimum frequency was
set as 10, and number of words per year was set as 5. In the recent 5 years, the topics were
neurostimulation, chronic neuropathic pain, failed back surgery syndrome, chronic pain,
neuromodulation, stimulation, spinal cord stimulation, complex regional pain syndrome,
satellite glial cells, macrophage, low back pain, pulse frequency, DRG neurons (Figure 7A).
It seemed that the current topics concentrated on clinical application of DRGS (e.g. chronic
neuropathic pain, FBSS, CRPS). Meanwhile, other topics (e.g. satellite glial cells,
macrophage, DRG neurons) also indicated some hotspots of basic research in DRGS.
Analyzing the local citations of articles can provide us with valuable insights into the
most fundamental and significant research in the field. The top 20 most local cited articles in
DRGS were shown in Table 4. Most of the highly cited articles (12/20), clustering from
1990s to 2000s, focused on the basic research. Eight DRGS-related clinical studies in the list,
on the contrary, have a considerable number of citations, rounding out the top three. DEER
TR and LIEM L have a good reputation in the field over the past decade, with four and two
papers in the citations ranking, respectively. The ratio of local citations to global citations can
reflect the focus of the paper to some extent. For example, the article published by
MCLACHLAN EM et al. in 1993, had a 10.10% LC/GC, indicating a broader coverage and
importance to other fields. In addition, we ranked the articles based on global citations and
presented the results in Table S2. Furthermore, top 20 articles with significant impact in this
field were evaluated by historiography analysis through LCS and GCS (Figure 7B and Table.
S3).

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Figure 7. Trend analysis of DRGS. A: trend topics in DRGS; B: Historiography of most-

cited articles in DRGS.

Table 4. Top 20 local cited articles in DRGS.

Ra Title Corresponding Journal Local Global LC/GC
nki author Citati Citatio Ratio
ng (Published year) ons ns (%)
1 Dorsal root ganglion stimulation DEER TR PAIN 126 276 45.65
yielded higher treatment success (2017)
rate for complex regional pain
syndrome and causalgia at 3 and
12 months: a randomized
comparative trial
2 A multicenter, prospective trial LIEM L (2013) NEUROMO 75 137 54.74
to assess the safety and DULATION
performance of the spinal
modulation dorsal root ganglion

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neurostimulator system in the

treatment of chronic pain

3 One-year outcomes of spinal LIEM L (2015) NEUROMO 67 143 46.85

cord stimulation of the dorsal DULATION
root ganglion in the treatment of
chronic neuropathic pain
4 Effect of electrical field KOOPMEINER NEUROMO 60 90 66.67
stimulation on dorsal root S AS (2013) DULATION
ganglion neuronal function
5 Peripheral nerve injury triggers MCLACHLAN NATURE 59 584 10.10
noradrenergic sprouting within EM (1993)
dorsal root ganglia
6 Spontaneous discharge KAJANDER NEUROSCI 56 346 16.18
originates in the dorsal root KC (1992) LETT
ganglion at the onset
of a painful peripheral
neuropathy in the rat
7 A prospective study of dorsal DEER TR NEUROMO 53 91 58.24
root ganglion Stimulation for (2013) DULATION
the relief of chronic pain
8 Stimulation of dorsal root VAN BUYTEN PAIN 42 74 56.76
ganglia for the management of JP (2015) PRACT
complex regional pain
syndrome: a prospective case
series
9 Spontaneous impulse generation BURCHIEL KJ EXP 40 119 33.61
in normal and denervated dorsal (1984) NEUROL
root ganglia: sensitivity to
alpha-adrenergic stimulation
and hypoxia
10 Mechanical and thermal SONG XJ J 39 230 16.96
hyperalgesia and ectopic (1999) NEUROPH
neuronal discharge after chronic YSIOL
compression of dorsal root
ganglia
11 The neuromodulation DEER TR NEUROMO 39 68 57.35
appropriateness consensus (2019) DULATION
committee on best practices for
dorsal root ganglion stimulation
12 Electrophysiological properties VILLIERE V J 38 177 21.47
of neurons in intact rat dorsal (1996) NEUROPH
root ganglia classified by YSIOL
conduction velocity and action
potential duration
13 Exposure of the dorsal root HIGUCHI Y NEUROSU 38 179 21.23
ganglion in rats to pulsed (2002) RGERY
radiofrequency currents
activates dorsal horn lamina I
and II neurons
14 Cross-excitation in dorsal root DEVOR M J 36 219 16.44
ganglia of nerve-injured and (1990) NEUROPH
intact rats YSIOL
15 Modulation of activity in dorsal DEVOR M J 36 227 15.86
root ganglion neurons by (1994) NEUROPH
sympathetic activation in nerve- YSIOL
injured rats
16 Pulsed and continuous VAN ANESTHES 36 162 22.22
radiofrequency current adjacent ZUNDERT J IOLOGY
to the cervical dorsal root (2005)
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ganglion of the rat induces late

cellular activity in the dorsal
horn
17 Functional changes in dorsal XIE YK (1995) J 35 165 21.21
root ganglion cells after chronic NEUROPH
nerve constriction in the rat YSIOL
18 Ca21-dependent exocytosis in HUANG LYM NEURON 34 248 13.71
the somata of dorsal root (1996)
ganglion neurons
19 Spinal cord stimulation of the SCHU S (2015) PAIN 34 73 46.58
dorsal root ganglion for groin PRACT
pain-a retrospective review
20 The appropriate use of DEER TR NEUROMO 30 255 11.76
neurostimulation of the spinal (2014) DULATION
cord and peripheral nervous
system for the treatment of
chronic pain and ischemic
diseases: the Neuromodulation
Appropriateness Consensus
Committee

Discussion
Bibliometrics helps researchers quickly gain an understanding of the research situation
and future trends in a certain field by analyzing and visualizing the academic literature. To the
best of our knowledge, this study is the first bibliometric study to provide a comprehensive
summary and trend analysis of DRGS. The research focus presented a gradual shift from basic
research to clinical application, indicating the successful translation of DRGS from bench to
bedside.
The number of articles and citations can effectively quantify the academic contribution
in this field. Although SCS has been used to treat chronic pain since 1967[24], it was not until
2009 that DRGS was actually considered for humans to treat pain[25-27]. Overall, the
number of DRGS-related articles has generally increased steadily, although fluctuating in
some years, which indicates a gradual intensification of enthusiasm for the field. Productive
authors have published most of the articles in the last decade. In particular, DEER TR not
only maintains high productivity but also publishes several articles with significant
contributions to the field. For affiliation, the University of Pittsburgh conducted research in
the early years, publishing 184 articles and making significant contributions to the field. For
countries/regions, there was no doubt that the USA dominated, which was consistent with the
top 10 affiliations (7/10 in the USA), both in terms of publication productivity articles and

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total citations. However, European countries were more prominent in terms of average article
citations compared to the USA, and only a few non-developed countries/regions made it into
the list. Overall, developed countries/regions are still the main contributors to the field.
Therefore, if researchers are seeking collaboration in DRGS, it is recommended that
researchers focus on the United States and Europe countries/regions.
The analysis of journals helps researchers to quickly focus on important research in the
field and guides the selection of appropriate journals to publish subsequent research.
NEUROSCIENCE, JOURNAL OF NEUROSCIENCE, PAIN, JOURNAL OF
NEUROPHYSIOL, and NEUROSCIENCE LETTERS are the top 5 productive journals in the
field. Taken together, the JOURNAL OF NEUROSCIENCE seems to be the preferred choice
for high quality research, while the NEUROSCIENCE could facilitate an efficient
understanding of significant research in the field. Moreover, based on both the number of
published articles and their impact factor, the JOURNAL OF PHYSIOLOGY-LONDON and
EUROPEAN JOURNAL OF NEUROSCIENCE have a strong inclination towards publishing
high-quality research. It was noted that most productive journals or impact journals
publishing DRGS-related articles belonged to specialized journals, which indicated that most
potential readers were pain physicians, neurosurgeons, or neuroscientists.
Themes analysis can help researchers better understand the past findings and the current
focus of DRGS. Combining the results from the LDA analysis and the thematic map, it was
noted that a gradual shift of research focus from basic research to clinical application,
indicating the successful translation of DRGS from bench to bedside. It seemed that the early
DRGS-related researches focused on the functional experiments of stimulating DRG cells,
disclosing the fact that DRGS not only modulating inflammation, but also improving nerve
regeneration. In the middle stage, researches concerning the molecular mechanism of DRGS
thrived up from 2000s, starting to figure out how DRGS functions at a molecular level. The
potential mechanisms by which DRGS functions include reducing action potential
propagation to the dorsal horn, stabilizing local cytokines and ions, decreasing the excitability
of the corresponding neurons, activating supraspinal centers, and promoting gene expression
in the DRG and spinal cord (Ca2+ /CaMKII/CREB signaling pathway, Wnt/β‑catenin pathway,
etc.)[26, 28-30]. In recent decades, a skyrocket publication growth was observed concerning
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the clinical application of DRGS. During the recent five years, clinical application of DRGS
and the molecular mechanism of DRGS still remained as the two dominant themes in this
field. Similarly, the historiography analysis of top-cited articles also indicated that the
research focus shifting from basic experiments to clinical researches.
While themes analysis disclosed the past and the current focus of DRGS, trend analysis
might indicate the future topics of DRGS. Trend topics indicated that the recent hotspots
were the clinical application of DRGS on modulating chronic pain. Specifically, researchers
were recently concerned about the efficacy and safety of DRGS in patients with various kinds
of chronic peripheral neurpathic pain. These clinical studies, especially clinical trials
compared with SCS, tended to produce high impact in the field of DRGS, which was
indicated by the top 20 local cited articles. By reviewing other clinical studies, the DRGS is
playing an increasingly important role in managing a wider kind of disease. For instance,
Kuwabara et al. tried to reduce cardiac arrhythmias by DRGS[31]. Mi et al. proved the
reliability of DRGS in enhancing osteoporotic fracture healing[30], and Quyang et al. tried to
modulate bladder function in the anesthetized feline model[32]. With the aging population
and the pursuit of quality of life, DRGS will have more applications and practical values.
Therefore, researches on the clinical application of DRGS, which were indicated in the left
bottom of the thematic map, will be emerging topics other than declining topics.
This study could not avoid the common problems of bibliometric analysis. A limitation
of this study is the choice of database. Since we only analyzed the WoSCC database, this may
lead to biased results of publication numbers and citations. An additional uncontrolled factor
is the timing of data collection. Only the publication activities before 2023 were analyzed in
this study. Third, the main information (titles, keywords, abstracts, etc.) rather than the full
text was analyzed in this study.

Conclusions
This study provide a comprehensive overview of the research status on DRGS, which may
benefit researchers to follow suitable journals or to pursue potential collaborations. The
research evolution present a gradual shift of research focus from basic research to clinical
application, indicating the successful translation of DRGS from bench to bedside. The current
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topics concentrated on clinical application of DRGS, and the future trend may be the clinical
application of DRGS in some particular diseases except for modulating chronic pain.

Supplementary Materials
Supplementary material A: Raw data. Supplementary material B: Table S1. The main
information of publications in DRGS. Table S2. The top 20 most cited articles (by global
citations) in DRGS research. Table S3. The publication list of historiography analysis.
Acknowledgments
We thank Dr. rer. nat. Joy Ramos-Gonzalez and Graduate School of Natural Sciences of
Leibniz University Hannover for helping with language polishing.
Author Contributions
Conceptualization, Guoxin Fan, Shisheng He and Xiang Liao; Data curation, Guoxin Fan;
Funding acquisition, Guoxin Fan and Xiang Liao; Investigation, Guoxin Fan and Qingtian
Luo; Methodology, Guoxin Fan, Chaobo Feng and Qingtian Luo; Project administration,
Shisheng He and Xiang Liao; Resources, Shisheng He and Xiang Liao; Software, Guoxin Fan,
Zhipeng Xu and Zhouyang Hu; Supervision, Shisheng He and Xiang Liao; Validation,
Zhipeng Xu; Visualization, Chaobo Feng; Writing – original draft, Chaobo Feng; Writing –
review & editing, Guoxin Fan, Zhipeng Xu, Qingtian Luo, Zhouyang Hu, Shisheng He and
Xiang Liao.
Funding Information
This work was funded by the National Natural Science Foundation of China (Grant No.
82102640), the Medical Scientific Research Foundation of Guangdong Province of China
(Grant No. A2023195), the National Key Research and Development Program of China
(Grant No. 2022YFC3602203), and Guangdong Basic and Applied Basic Research
Foundation (Grant No. 2023A1515010144), Shenzhen Science and Technology Program
(Grant No. JCYJ20220530142000001).
Conflict of Interest
Authors declare that there is no conflict of interest regarding the publication of this paper.

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