Combined therapy of pulsed radiofrequency and nerve block in postherpetic neuralgia patients: a randomized clinical trial

Abstract

Caused by viral infection, postherpetic neuralgia (PHN) is the most common chronic neuropathic pain. Various treatment modalities such as early use of nerve block therapy (NBT) and pulsed radiofrequency (PRF) have been studied in reducing pain, however, no consistent success was achieved in all the patients treated with single regimen. The combined therapy of PRF and NBT with different targeting mechanism are of interest and remains to be determined. Here we investigated the combined effects of pulsed radiofrequency (PRF) with nerve block therapy (NBT) in PHN patients in a prospective randomized clinical trial. Sixty PHN patients were divided into four groups (n = 15 each): the conventional puncture group (group CP), the nerve block therapy group (group NB), the PRF group (group PRF), and the combined treatment group (PRF combined with nerve block therapy (group CT). To evaluate the extent of remission of hyperalgesia, we recorded the visual analogue scale (VAS) scores during cotton swab reaction before and after treatment and in the resting and active pain states. In addition, blood samples were collected and plasma cytokine and neuropeptides such as interleukin-6 (IL-6), substance P (SP), and β-endorphin (β-EP) were measured by enzyme-linked immunosorbent assay (ELISA) at the admission (basic state), before the operation, and at 12 h postoperatively. The number of adverse events (nausea, vomiting, constipation, puncture point hemorrhage, swelling and redness) within 12 h of the treatment were also documented. Our results showed that VAS scores during cotton swab reaction decreased after treatment in all patients (p < 0.05). Compared to group CP, plasma IL-6 and SP levels decreased (p < 0.05) and β-EP levels increased (p < 0.05) in groups NB, PRF, and CT. There were no significant differences in adverse events among groups (p > 0.05). We found that PRF in combination with NBT increased β-EP levels and decreased plasma IL-6 and SP, thereby alleviating pain and hyperalgesia in PHN patients. Taken together, our data suggest combined therapy of PRF and NBT is effective and safe for PHN patients.

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

“…Surgical puncture and PRF may cause transient nerve edema and pain aggravation ( 35 ), and PRF treatment has a slower onset ( 2 ). Thus, the combined application of PRF and nerve block in this study will achieve better therapeutic effects ( 36 , 37 ).…”

Efficacy of different interventions for the treatment of postherpetic neuralgia: a Bayesian network meta-analysis

“…Table 1 describes the summary of the 12 included studies that were published between 2010 and 2017. 15 – 26 There were 702 participants with an age range from 57.06 to 73.53 years. Among these included studies, two focused on the efficiency of subcutaneous BTX-A, 21 , 26 three focused on NB, 15 – 17 five studies focused on PRF therapy, 15 , 16 , 19 – 21 one study focused on PRF + NB, 17 one study focused on PRF + NB + SC, 19 three studies focused on SC, 23 , 24 , 26 one study focused on SC + NB, 24 one study focused on SC + NB + O3 injection, 24 and one study focused on SGB.…”

“…25 The detailed parameters, methods, and drug dosages are listed in Table 1 . For oral medication, among nine studies, 16 – 24 all patients regularly took oral calcium channel regulators (first-line drugs for PHN treatment); however, in one study, 25 only some patients took calcium channel regulators, while in two studies, 26 , 27 no patients took these medications.…”

Ultrasound-Guided Inactivation of Trigger Points Combined with Muscle Fascia Stripping by Liquid Knife in Treatment of Postherpetic Neuralgia Complicated with Abdominal Myofascial Pain Syndrome: A Prospective and Controlled Clinical Study

“…So far, however, there has been no reliable and effective way to eliminate this neuralgia, and many patients in whom PHN treatment is effective are prone to pain recurrence [12]. For many years, in our pain department, the conventional method for the treatment of PHN is that PHN with mild to moderate pain (6 > VAS > 2) is treated with paravertebral nerve block in spinal cords segments corresponding to herpes distribution area combined with oral drugs; patients with severe pain (VAS > 6) or patients in whom the above treatment is ineffective are treated with epidural or intrathecal analgesia pump [13], spinal cord electrical stimulation [14], transcutaneous electrical stimulation, nerve root radiofrequency thermocoagulation or pulse radiofrequency ablation [15], etc. is study focuses on the treatment of PHN patients with mild to moderate pain.…”