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Meta-Analysis
. 2022 Mar 18;101(11):e29073.
doi: 10.1097/MD.0000000000029073.

Comparing the efficacy and safety of short-term spinal cord stimulation and pulsed radiofrequency for zoster-related pain: A systematic review and meta-analysis

Song Xue  1 , Wen-Jie Yang, Zhen-Xin Cao, Tao Sun
Affiliations
Meta-Analysis

Comparing the efficacy and safety of short-term spinal cord stimulation and pulsed radiofrequency for zoster-related pain: A systematic review and meta-analysis

Song Xue et al. Medicine (Baltimore). .

Abstract

Background: Pulsed radiofrequency (PRF) is a commonly used method for the treatment of zoster-related pain in the clinic. However, PRF therapy has a high recurrence rate and many adverse reactions. Recent studies have shown that short-term spinal cord stimulation (stSCS) can effectively alleviate zoster-related pain. Due to the lack of evidence, it is unclear whether stSCS is superior to PRF in the efficacy of treating zoster-related pain.

Objective: This study aimed to compare the efficacy and safety of stSCS and PRF for zoster-related pain.

Methods: We searched seven electronic databases from the establishment of the database to January 2021. Related randomized controlled trials were included in this meta-analysis. After extracting the data and evaluating the methodological quality of the included trials, the outcome indicators were statistically analyzed by using RevManV.5.3.

Results: This meta-analysis included 6 trials with a total of 509 patients. Compared with PRF group, stSCS group showed lower pain intensity (standardized mean difference=-0.83, 95%CI [-1.37, -0.30], P=.002), better sleep quality (mean difference=-1.43, 95%CI [-2.29, -0.57], P=.001), lower pain rating index scores, and less incidence of adverse events (RR=0.32, 95%CI [0.12, 0.83], P<.05). However, the efficacies of PRF and stSCS for treating postherpetic neuralgia were consistent in the response rate (RR= 1.10, 95% CI [0.82, 1.48], P=.51) and the complete remission rate (RR=1.05, 95% CI [0.66, 1.68], P=.84).

Conclusions: In this study, stSCS showed a better analgesic effect and higher safety than PRF. Our meta-analysis results suggested that stSCS may be a feasible and safe invasive treatment for zoster-related pain. However, high-quality, randomized controlled trials with large sample sizes are needed to further verify our conclusions.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

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Figure 1. Flow diagram of literature retrieval.
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Figure 2. Summary chart of bias risk of included studies.
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Figure 3. Risk of bias for each included study.
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Figure 4. Comparison of stSCS and PRF in relieving pain intensity at the end of follow-up.
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Figure 5. Comparison of stSCS and PRF in relieving pain intensity at different follow-up time points.
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Figure 6. Comparison of stSCS and PRF in relieving pain intensity for patients with a mean course of disease less than 3months.
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Figure 7. Comparison of stSCS and PRF in relieving pain intensity for patients with a mean course of disease of more than 3 months.
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Figure 8. Comparison of stSCS and the higher-voltage and longer-duration PRF in relieving pain intensity.
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Figure 9. Comparison of stSCS and PRF in the response rate.
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Figure 10. Comparison of stSCS and PRF in the complete remission rate.
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Figure 11. Comparison of stSCS and PRF in the PSQI at the end of follow-up.
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Figure 12. Forest plot of adverse events.
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Figure 13. Funnel diagram of pain intensity at the end of follow-up.
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