Background: Some 7.7% of the Chinese population suffer from herpes zoster each year, with
29.8% proceeding on to develop postherpetic neuralgia (PHN). This amounts to over 32 million
people per year. PHN is preceded by 2 phases of pain: acute herpetic neuralgia (AHN), and subacute
herpetic neuralgia (SHN). Considering the large individual and economic burden, preventing the
transition of AHN/SHN to PHN is crucial. However, to date this has been difficult.
Objectives: To evaluate the efficacy of temporary spinal cord stimulation (tSCS) treatment and
prevention of PHN.
Study Design: A retrospective, observational study.
Setting: Department of Pain Medicine.
Methods: From 2013 to 2017, 99 patients with AHN (n = 42), SHN (n = 34), and PHN (n = 23)
underwent tSCS treatment (7-14 days) after failed pharmacologic and interventional therapies.
Visual analog scale (VAS), Pittsburgh Sleep Quality Index (PSQI), and analgesic consumption were
recorded at baseline, post-tSCS, and 1, 3, 6, and 12 months after tSCS treatment.
Results: Pooled results demonstrated statistically significant decreases in VAS scores and PSQI
post-tSCS and at 1, 3, 6, and 12 months follow-up (P < 0.001). When compared with the PHN
group, both AHN and SHN groups were clinically and statistically improved in VAS scores and PSQI
(P < 0.001). Analgesic consumption decreased in all 3 groups after tSCS treatment, and downward
linear gradient of medication in the AHN group was more significant than that in the SHN and
PHN groups. At 12 months follow-up, 2.5% (1/40) patients in the AHN group, 16.0% (4/25) in the
SHN group, and 62.5% (10/16) in the PHN group had ongoing pain ≥ 3/10 VAS score requiring
analgesia. Expressed differently, at 12 months, 97.5% of the AHN group and 84% of the SHN
group had pain of 2/10 VAS score or less versus only 37.5% of the PHN group.
Limitations: This was a single-center, retrospective study, which made it difficult to collect
complete data for all variables. The therapeutic effect of tSCS could not be studied independently.
Conclusions: This retrospective analyses of 99 patients treated with tSCS (7-14 days) suggests
that tSCS may be effective for treating and preventing PHN. Early treatment within 4 to 8 weeks
was more likely to result in pain ≤ 2/10 VAS score, improvement in sleep, and no requirement for
analgesia at 12 months. Early tSCS may be a promising prevention strategy against the development
of chronic neuropathic pain following herpes zoster infection. Further research is justified.
Key words: Herpes zoster, zoster-related pain, postherpetic neuralgia, temporary spinal cord
stimulation
