Development of a Model for Predicting the Effectiveness of Pulsed Radiofrequency on Zoster-Associated Pain

Abstract

Introduction: Zoster-associated pain (ZAP), which may cause anxiety, depression, and sleep disorders and reduce quality of life, is often refractory to current standard treatments. Studies have shown that pulsed radiofrequency (PRF) can alleviate ZAP and reduce the incidence of postherpetic neuralgia (PHN). This study aimed to explore the clinical characteristics associated with PRF responsiveness, develop a model for identifying risk factors of inadequate PRF management, and help clinicians make better decisions. Methods: Patients who underwent PRF for ZAP between January 2017 and October 2020 in our hospital were included in this study. Patients were evaluated using the numerical rating scale (NRS), Insomnia Severity Index, Patient Health Questionnaire-9, and 36-Item Short Form Health Survey (SF-36) before and 3 months after the procedure. Patient demographic data and blood test results were also collected. We defined the effectiveness of PRF for ZAP as relief of [ 50% in NRS scores compared to pre-PRF. Least absolute shrinkage and selection operator (LASSO) regression analyses were subsequently performed to identify factors related to the therapeutic effect of PRF in patients with ZAP. The performance of the prediction model was assessed by the area under the receiver operating characteristic curve (AUC). Results: The effectiveness of PRF in patients with ZAP was 69.6% (total 313 patients) after 3 months. LASSO regression analysis extracted the seven most powerful features in the developed prediction model: sex, stage of herpes zoster (HZ), pregabalin dose, bodily pain indicators of SF-36, lymphocyte count, and low-density lipoprotein cholesterol (LDLC) and complement C4 in peripheral blood. Model = 1.586 ? 0.148 9 lymphocyte ? (-0.001) 9 bodily pain indicators of SF-36 ? (-0.001) 9 pregabalin dose ? 0.028 9 LDLC ? 0.001 9 C4 ? (-0.508) 9 sex ? (-0.128) 9 stage of HZ. We generated the ROC curve for the prediction model, and the final AUC was 0.701. The sensitivity, specificity, and overall accuracy of the model were 90%, 33%, and 73%, respectively. Conclusions: Seven factors were significantly associated with poor PRF outcome: male sex,

Risk Factors for Poor Pain Control in Zoster-Associated Pain: A Retrospective Study

“…Disease-related characteristics included complications (diabetes, cancer), course of disease, location of nerve block therapy, and NRS score on admission (admission NRS). Laboratory indicators included white blood cell (WBC) count, red blood cell (RBC) count, neutrophil percentage (NEU%), lymphocyte percentage (LYM%), total protein (TP), and albumin (ALB) on admission [ 8 , 13 , 14 ].…”

The complement system: a potential target for the comorbidity of chronic pain and depression

“…Zoster sine herpete is one of the atypical clinical manifestations of herpes zoster, which stems from infection and reactivation of the varicella-zoster virus in the cranial nerve, spinal nerve, viscera, or autonomic nerve [ 15 ]. Peng et al [ 16 ] conducted a significant clinical investigation employing least absolute shrinkage and selection operator regression analysis to develop a predictive model for assessing the efficacy of pulsed radiofrequency (PRF) in managing Zoster-associated pain. Their findings revealed a significant correlation between lower levels of complement C4 in peripheral blood and poor PRF outcomes, which holds potential implications for tailoring personalized treatment approaches in the future.…”

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

“…Spinal nerve DRG radiofrequency is considered an effective intervention for the treatment of PHN, given its low invasiveness, good accuracy, reproducible operation, low recurrence rate, high effectiveness, and safety and reliability [ 13 , 14 ]. Although pulsed radiofrequency (PRF) has been shown to yield definite analgesic efficacy in treating herpes zoster-associated pain, some patients have insignificant pain relief and a high short-term recurrence rate after treatment, and often require additional pain relief treatment [ 15 – 17 ]. Radiofrequency thermocoagulation (RF-TC) enables the destruction of the DRG with significant pain relief and high efficiency [ 18 , 19 ].…”