OBJECTIVE: To evaluate the efficacy and safety of the novel ultrasound-guided cervical sympathetic chain pulsed radiofrequency (PRF) for subacute herpes zoster neuralgia.
MATERIALS AND METHODS: Sixty patients with subacute herpes zoster neuralgia (one month until the third month after the rash onset) on the maxillofacial, head, and neck regions were enrolled in our study. Patients were randomized into two groups: sham-operated (sham) group (n = 30) and radiofrequency (RF) group (n = 30). In the RF group, the affected side cervical sympathetic chain was treated with bipolar high voltage long-duration PRF. In the sham group, the RF cannula was placed at the same position as in the RF group, but without RF energy application. The visual analog scale (VAS), Pittsburgh Sleep Quality Index (PSQI), 36-item Short Form Health Survey (SF-36), analgesic drug usage, incidence of postherpetic neuralgia, and adverse effects were recorded in both groups.
RESULTS: In both groups, compared with preoperative, VAS and PSQI scores decreased, while SF-36 scores improved after the treatment (p < 0.05). The VAS and PSQI scores were significantly lower, whereas the SF-36 scores were significantly higher in the RF group than in the sham group at 1, 30, 90, and 180 days after the treatment (all p < 0.05), and the amount of analgesic drugs consumption was also lower in the RF group than in the sham group (p < 0.05). The incidence of postherpetic neuralgia was lower in the RF group than in the sham group (p < 0.05). No noticeable complications and side effects were observed in either group.
CONCLUSION: The novel ultrasound-guided cervical sympathetic chain pulsed radiofrequency could effectively relieved subacute herpes zoster neuralgia (one month until the third month after the rash onset) on the maxillofacial, head, and neck regions, and reduced the incidence of postherpetic neuralgia.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
The decrease in long-term effects is notable and warrants further study. While it’s unclear to me whether the “sham” procedure was done in a way to truly allow for symptom comparisons, it was a good initial study worth further more vigorous exploration of the intervention.
Physician rater
Herpes zoster neuralgia and post-herpetic neuralgia are very frequent in clinical practice and cause pain and disability in a lot of patients. Medication is not always effective and usually produces troublesome adverse effects. New treatment strategies are emerging and are worth testing when performed by experienced professionals with a clear explanation of scope and limitations.
Physician rater
This is an interesting RCT assessing the impact of pulsed radiofrequency in reducing pain and improving quality-of-life in subacute herpes zoster neuralgia. Although limited in sample size, there was adequate randomization between the sham group and the pulsed radiofrequency intervention group. This study looked at on pregabalin and tramadol analgesic use, which is a limitation of the study. Given adequate randomization, the result of this study shows significant improvement with pulsed radiofrequency compared with the sham/control group. However, further studies with increased sample size are needed. Future studies may also need to consider looking at other analgesic pain medications.
, McMaster University