Analysis of Efficacy and Factors Associated with Reccurence After Radiofrequency Thermocoagulation in Patients with Postherpetic Neuralgia: a Long-Term Retrospective and Clinical Follow-Up Study

Abstract

Introduction: Postherpetic neuralgia (PHN) is a painful condition that persists for 1 month or more after herpes zoster rash has healed. Radiofrequency thermocoagulation (RF-TC) provides analgesia by destroying the dorsal root ganglion and blocking the pain upload pathway; nonetheless, the concomitant neurological-related side effects and recurrence remain a concern. Methods: In this study, 228 patients with PHN in the thoracic segment treated with RF-TC of the dorsal root ganglion of the spinal nerve were included, and were followed up regularly after surgery. The numerical rating scale (NRS) scores, time to recurrence, and intraoperative and postoperative adverse events were recorded and analyzed. The Kaplan-Meier method was used to plot survival curves and calculate the cumulative effective rate and recurrence rate. Cox regression analyses were performed to identify factors associated with postoperative recurrence. Predictive models were built to assess the value of applications. Results: The NRS scores decreased in all postoperative periods compared with preoperative ones. At 10-year-follow-up, recurrence was observed in 34.6% (79/228) of patients that underwent PHN. The main postoperative complications were numbness and reduced abdominal muscle strength, which gradually decreased with time, while the abdominal muscle strength gradually recovered. No other adverse events occurred. Interval-censored multivariable Cox regression analysis demonstrated that disease course, complications, pain grade, and type of RF electrode were associated with a significantly higher risk of relapse. The main intraoperative adverse effect was a transient increase in pain during RF-TC. Conclusion: CT-guided RF-TC of the dorsal root ganglion of the spinal nerve for PHN is a relatively safe and effective surgical option. Disease course, type of RF electrode, complications, and pain grade are risk factors for postoperative recurrence and can assist in clinical decisionmaking before the RF-CT procedure.

A bibliometric and visualization analysis of global research on postherpetic neuralgia from 2000 to 2022: A review

“…PHN is a well-known type of intractable neuropathic pain, [ 31 ] which is the most common and severe complication of HZ. [ 32 ] The reason for the pain of PHN is that HZ is reactivated by the varicella-zoster virus that is latent in the body. The virus reaches the affected area along the descending sensory nerve, destroying the peripheral nerve tissues such as the dorsal root ganglia and the peripheral nerve, causing local tissue damage and inflammatory reaction, sensitizing peripheral nociceptors, and then developing into central sensitization, causing spontaneous pain and hyperalgesia.…”

Progress in Radiofrequency Therapy for Zoster-Associated Pain About Parameters, Modes, Targets, and Combined Therapy: A Narrative Review

“…This indicates that radiofrequency thermocoagulation has the potential to provide superior pain relief. Another study by Zhang et al followed patients who received radiofrequency thermocoagulation therapy for PHN for up to 10 years [25]. The study concluded that this therapy was safe and effective, with a 1-year recurrence rate of 22.2% and an overall recurrence rate of 47.9% at 10 years.…”

Comparison and Multivariate Analysis of Radiofrequency and Pulsed Radiofrequency in the Treatment of Postherpetic Neuralgia

“…locally, Aδ and C bers will be destroyed, so as to minimize the pain of patients [29][30][31] . It has also been reported that 80℃ can nally retain Aα and Aβ bers, effectively reduce the pain of patients while preserving their sense of touch.…”