Efficacy of CT Guided Pulsed Radiofrequency Treatment for Trigeminal Postherpetic Neuralgia

Abstract

Objectives Trigeminal postherpetic neuralgia (TPHN) often presents with moderate to severe pain, hyperalgesia, and allodynia. Conventional analgesic treatments are poorly effective, which seriously affects the quality of life. This retrospective study aimed to evaluate the efficacy of pulsed radiofrequency (PRF) for the treatment of TPHN. Methods A total of 90 TPHN patients were selected between January 2014 and December 2016 in the Department of Pain Management, Shengjing Hospital, China Medical University. Patients were randomly divided into two groups according to the order of enrollment ( n = 45 per group): group A, peripheral nerve (supraorbital nerve, infraorbital nerve and mental nerve) PRF; group B, gasserian ganglion PRF. Follow-up assessments of visual analogue scale (VAS) pain assessment, SF-36 health status questionnaire, total efficiency rate, and drug dosage of anticonvulsants and opioid analgesics were performed at time points of 1 week, 1 month, 3 months, 6 months, and 1 year after surgery. Results At each postsurgery time point, the VAS decreased, SF-36 (physical and mental components) increased, and drug dosage of anticonvulsants and opioids analgesics decreased in both treatment groups; values at each time point were significantly different from presurgery values ( P < 0.05). Compared with group A, VAS decreased, SF-36 increased, and dosage of anticonvulsants and opioids analgesics decreased significantly in group B ( P < 0.05). The total efficiency rates one year after surgery in group A and group B were 68.9 and 86.7%, respectively. The total efficiency rate of group B was statistically higher than that of group A ( P < 0.05). Conclusion PRF relieved TPHN, and gasserian ganglion PRF was more effective than peripheral nerve PRF. The method was effective and improved the quality of life of the patients. PRF is recommended as a treatment for TPHN.

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

“…PRF can block pain transmission by interrupting signals in unmyelinated C fibers and myelinated A-delta fibers without influencing myelinated A-alpha and A-beta fibers. 31 Moreover, PRF appears to change c-fos mRNA expression in the dorsal horn of spinal cord. 32 In our NMA, PRF was highly effective for pain reduction in PHN patients at all time points compared among all the analyzed interventions.…”

Bioinformatics Analysis of Genes and Mechanisms in Postherpetic Neuralgia

“…Elderly patients are prone to postherpetic neuralgia (PHN) following VZV-induced herpes zoster [ 25 ]. Thoracic, cervical, and trigeminal nerves are commonly involved in PHN [ 26 , 27 ], which may cause anxiety, depression, sleep disorders, and other complications. As a result, the life quality of elderly patients was seriously reduced [ 28 ].…”

Efficacy of Pulsed Radiofrequency to Cervical Nerve Root for Postherpetic Neuralgia in Upper Extremity

“…It is dispensed in a short interval of 20 ms and then intermittently for 480 ms so that the generated heat is diffused and the temperature produced does not exceed 42 • C. Therefore, PRF only produces persistent neuromodulation and does not produce a destructive effect as RFT. Recent studies have found that PRF can produce neuromodulation and relieve trigeminal PHN (Ding et al, 2019). It has been found that PRF can inhibit the nociceptive-induced release of excitatory neurotransmitters (Huang et al, 2016), reduce the expression of calcitonin gene-related peptide (CGRP) in DRG (Ren et al, 2018), inhibit the expression of P2 × 3 receptor in DRG and spinal dorsal horn (Fu et al, 2019), and reduce the expression of peripheral of pro-inflammatory cytokines (TNF-α and IL-6) and β-Catenin in spinal cord (Vallejo et al, 2013;Jiang et al, 2019); At the same time, PRF can up-regulate GDNF transcription and translation (Jia et al, 2016;Hailong et al, 2018), up-regulate GABAB-R1, Na/K ATPase and 5-HT3r gene expression (Vallejo et al, 2013), increase histone acetylation and KCC2 expression by modifying KCC2 and partially restored GABA synaptic function (Liu et al, 2017).…”