The effect of interventional pain management on treating postherpetic neuralgia

Abstract

Background: Herpes zoster (HZ) is identified to induce postherpetic neuralgia (PHN) which is difficult to cure. PHN-related pain brings patients not only physical discomfort but also mental depression and anxiety. Currently, the main purpose of PHN treatment is to reduce patients’ pain. Now treatment combining some international pain management and drug therapy has come up. Aims and Objective: This study aims to evaluate the effect of interventional management through meta-analysis. Materials and Methods: Interventional pain management was defined as a direct strategy on nerve through physical or chemical method. Drug therapy was always regarded as control. Potentially relevant articles were searched in PubMed, EMBASE, and the Cochrane Library through key words by consensus. Pain severity was evaluated by a validated visual analog scale (VAS). Moreover, the weighted mean difference was used to calculate pain intensity. Some trails recorded the efficiency rate and odds ratio was used to calculate the effectiveness. Statistical heterogeneity was measured by the value of I 2 , and when statistical I 2 > 50%, subgroup analysis was used to seek for the source of heterogeneity. Results: Pulsed radiofrequency (PRF) combined with medication reduced the VAS scores at 1, 2, 4, and 8 weeks after treatment. The nerve block combined with medication reduced VAS scores at 8 weeks after treatment, but there is no difference between the results of medication alone at 1, 2, and 4 weeks after treatment. Conclusion: The interventional mean of PRF combined with medication has a good effect on PHN. The effect of nerve block combined with medication on PHN seems to be the same as that of medication alone. Besides, a long period with high-quality randomized controlled trial should be done to verify the results.

Effective Treatment of Postherpetic Neuralgia at the First Branch of the Trigeminal Nerve by High-Voltage Pulsed Radiofrequency

“…In elderly patients, especially those with multiple concomitant diseases, the side effects of medications limit the use of analgesic drugs ( 11 ). Patients with intractable pain even after conservative treatment require invasive treatments ( 12 ).…”

Efficacy of Dorsal Root Ganglion Pulsed Radiofrequency Combined with Paravertebral Injection of Recombinant Human Interferon-α2b in Herpetic Neuralgia

“…The study for PHN also confirmed the effectiveness and safety of pulsed radiofrequency in DRG, and achieved immediate effect, but it failed to significantly reduce the incidence of PHN. 7,8 Although pulsed radiofrequency can cause analgesia, there is no treatment for antiviral and immune system regulation at the target, which may be the main reason for its unsustainable efficacy.…”

“…Gao et al and others reported that the incidence of PHN was still not less than 10% after Herpes zoster patients treated with recombinant human interferon-α2b after paravertebral injection. 7 Although this method can effectively have antiviral effect and improve the immunity of patients, it cannot significantly reduce the incidence of PHN.…”

The Effect of CT-Guided Pulsed Radiofrequency Combined with Ozone Injection on Zoster-Associated Pain: A Retrospective Study

“… 4 PHN is associated with long-lasting neurohypersensitivity that can have undesirable mental consequences such as depression, fatigue and sleep disorders. 5 Therefore, improving therapeutic effectiveness, preventing the occurrence of PHN, and achieving rapid pain relief for patients with zoster-associated pain (ZAP) have been a focus of attention for pain physicians.…”