CT-Guided Pulsed Radiofrequency at Different Voltages in the Treatment of Postherpetic Neuralgia

Abstract

BackgroundPostherpetic neuralgia (PHN) is a form of long-lasting neuropathic pain that can severely affect patients’ quality of life. Pulsed radiofrequency (PRF) has been proven to be effective in treating PHN, but the optimal radiofrequency parameters are still not well defined. This retrospective study aimed to compare the efficacy and safety of CT-guided PRF at three different voltages for the treatment of PHN patients.MethodsThis study included 109 patients with PHN involving the thoracic dermatome who were treated in the Department of Pain Management of Shengjing Hospital, China Medical University, from January 2017 to May 2019. They were divided into three groups based on the PRF voltage used: group A (45 V), group B (55 V), and group C (65 V). The PRF therapy (voltage 45, 55, and 65 V) was performed in all patients by targeting the thoracic dorsal root ganglion. After surgery, patients were followed at 3 days, 1 month, 3 months, 6 months, and 12 months. Observation at each follow-up included basic patient characteristics, visual analog scale (VAS), 36-Item Short Form Health Survey (SF-36) scores, patient satisfaction, complications, and side effects.ResultsVisual analog scale scores decreased and SF-36 scores increased for all patients in the three groups at each post-operative time point (1, 3, 6, and 12 months; all P < 0.01). Pain relief, improvement in quality of life, and overall satisfaction were more significant for patients in group C than for those in groups A and B at the 3-, 6-, and 12-month follow-ups (all P < 0.05). Patients in group B had lower VAS scores and higher overall satisfaction levels than those in group A (both P < 0.01). A small number of patients from each group (n ≤ 3) experienced mild intraoperative and post-operative complications, which bore no relationship with group assignment (all P > 0.05). At post-operative day 3, patients in group C had skin numbness affecting a larger area than patients in the other two groups (both P < 0.05), but the differences were no longer statistically significant at day 30 after the operation. All patients experienced a drop in numbness area of more than 30% after surgery.ConclusionCompared with PFR at 45 and 55 V, PFR at 65 V had superior efficacy in treating PNH, with a favorable safety profile.

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

“…Heavner et al studied PRF test on fresh egg white that the results showed that when the needle tip temperature was higher than 60°C, egg white produced typical coagulation necrosis, suggesting that attention should be paid to control the temperature of the needle tip during PRF to minimize the thermal damage to the tissue ( 22 ). In this study, the maximum voltage was controlled at 65V and the temperature was controlled below 50°C to avoid nerve injury caused by further increase of voltage and temperature ( 8 ). In this study, the VAS score of group H was lower than that of group C at 1, 3, and 6 months after the treatment, indicating that high-voltage PRF treatment of ocular branch PHN is more effective than conventional PRF.…”

“…The results of our previous study showed that high-voltage PRF could treat PHN in the thoracolumbar region well, and the effect of 65 V high-voltage PRF in relieving PHN was significantly better than that of 45 V and 55 V (8). However, the effectiveness of treatment for the first branch of the trigeminal nerve PHN is unknown.…”

“…The nature of pain in PHN is severe pinprick-like, burning, or electric shock-like pain in the lesion area, leading to unbearable and excruciating pain, which seriously affects the patient's quality of life and work. Current treatment options mainly include the use of analgesic drugs ( 6 ), nerve blocks ( 7 ), radiofrequency therapy ( 8 ), analgesic pump implantation ( 9 ), and spinal cord electrical stimulation ( 10 ). In elderly patients, especially those with multiple concomitant diseases, the side effects of medications limit the use of analgesic drugs ( 11 ).…”

Computed Tomography-Guided Radiofrequency Ablation of the Cervical Dorsal Root Ganglia in 27 Patients with Cervical and Occipital Postherpetic Neuralgia

“…However, the tissue temperature near the electrode rose as high as 50°C when the PRF voltage was increased to 65. The area of skin numbness also was larger on the third day after the operation, but there were no significant differences from the other 2 voltage groups at 30 days after the procedure [ 9 ]. Lin et al [ 10 ] found that computed tomography (CT)-guided RFA of patients with cervical (C8)-thoracic (T1) PHN reduced their pain.…”

Observation and measurement of applied anatomical features for thoracic intervertebral foramen puncture on computed tomography images

“…Interventional therapy on the thoracic nerve roots or dorsal root ganglia (DRGs) is an important means to relieve chronic pain of the chest and abdomen, such as postherpetic neuralgia, incision pain, or other thoracic nerve pain[ 1 - 3 ]. The thoracic intervertebral foramina (TIVFs) are the most direct and frequently used channels for reaching the DRGs with interventional tools[ 4 , 5 ].…”