Efficacy of Pulsed Radiofrequency or Short-Term Spinal Cord Stimulation for Acute/Subacute Zoster-Related Pain: A Randomized, Double- Blinded, Controlled Trial

Abstract

Background: Postherpetic neuralgia (PHN) is the final stage of varicella zoster infection and a severe refractory neuropathic pain. Hence preventing transition of herpes zoster-related pain to PHN is a very important therapeutic principle for patients at an early stage, especially for older patients.Both pulsed radiofrequency (PRF) and short-term spinal cord stimulation (stSCS) have been proven to be effective to relieve acute/subacute zoster-related pain. However, which treatment could achieve better analgesic effects remains unclear. Objectives: This study aimed to investigate the therapeutic efficacy and safety of PRF and stSCS in patients with acute/subacute zoster-related pain. Study Design: Prospective, randomized, double-blinded study. Setting: Department of Pain Medicine, the First Affiliated Hospital of China Medical University. Methods: Ninety-six patients with acute/subacute zoster-related pain were equally randomized into 2 groups: PRF group and stSCS group. Patients in the different groups were treated with high-voltage, long-duration PRF or stSCS. The therapeutic effects were evaluated using a Numeric Rating Scale (NRS-11) and the 36-Item Short Form Health Survey (SF-36) at different time points. The average dose of pregabalin (mg/d) administrated at different time points was also recorded. Results: The posttreatment NRS-11 scores in the 2 groups were significantly lower compared with baseline (P < 0.001). The NRS-11 scores in the stSCS group were significantly lower than those in the PRF group at 30 and 180 days after treatments (P < 0.05). The SF-36 scores of general health, social function, role-emotional, mental health, bodily pain, physical function, physical role, and vitality could be significantly improved at each time point after treatments in the 2 groups. Some SF-36 scores could be significantly improved at some time points in the stSCS group compared with the PRF group. The rescue drug (pregabalin) dosages were lower in the stSCS group than those in the PRF group at days 90 and 180 after treatments. There was no bleeding at the puncture site, infection, postoperative paresthesia, nerve injury, or any other serious adverse effects in either group. Limitations: Single-center study, relatively small number of patients. Conclusions: PRF and stSCS are both effective and safe therapeutic alternatives for patients with acute/subacute zoster-related pain, however, stSCS could achieve more pain relief and improvement of life quality compared with PRF. Key words: Pulsed radiofrequency, short-term spinal cord stimulation, zoster-related pain, Numeric Rating Scale, 36-Item Short Form Health Survey

Case Report: Short-Term Spinal Cord Stimulation and Peripheral Nerve Stimulation for the Treatment of Trigeminal Postherpetic Neuralgia in Elderly Patients

“…Researchers have observed that electrical stimulation of the dorsal column did not only attenuate dorsal horn neuronal excitability but inhibited spinal wide-dynamicrange neuronal activity in neuropathic pain models (40). Our previous study showed that performing short-term SCS during the early stages of PHN could help prevent the development of pain hypersensitivity and reverse the development of peripheral and central sensitization (28). Stevanato et al reported that PNS could affect changes in nociceptive signals that normalized peripheral and central sensitization leading to a reduction of allodynia (41).…”

“…SCS has been successfully used to treat HZ-related pain at the cervical, thoracic and lumbar segments (26)(27)(28). The lead is placed into the epidural space to stimulate the dorsal spinal cord columns, activate inhibitory interneurons and attenuate ascending pain transmission (29).…”

Efficacy of Long-Term Spinal Nerve Posterior Ramus Pulsed Radiofrequency in Treating Subacute Herpetic Neuralgia: A Prospective Randomized Controlled Trial

“…As neuropathic pain, HZN is manifested as sponta-neous allodynia and hyperalgesia in the damaged skin area, which persists for a long time. Its incidence is closely related to aging, and various analgesics (such as antiepileptics, tricyclic antidepressants, and opioids) have varying degrees of analgesic effects on HZN [22][23][24]. However, the neuropathic pain it produces cannot be completely con-trolled.…”

Propensity score matching comparing short-term nerve electrical stimulation to pulsed radiofrequency for herpes zoster-associated pain: A retrospective study

“…We found that both PRF and st-NES could induce pain alleviation, and pain relief reported in patients treated with st-NES is higher than in those treated with PRF at any time interval. A previous study enrolled 91 AHN and SHN patients, followed up to 6 months, then observed that st-SCS achieved better pain relief than PRF for ZAP at 1-and 6-month follow-ups ( Song, 2021 ). In addition, a recent study with a sample size of 70 PHN patients and a follow-up period of 12 months demonstrated that the VAS scores in the st-SCS group were reported notably lower than those in the PRF group at 3, 6, and 12 months after treatment ( Sheng et al, 2022 ).…”

“…However, it is still unclear which technique provides improved analgesia in ZAP. Previously published studies comparing the efficacy of st-NES and PRF for ZAP are inconsistent (Liu et al, 2020;Song, 2021;Sheng et al, 2022).…”