Efficacy and safety of pulsed radiofrequency combined with pregabalin for herpetic neuralgia: A systematic review and meta-analysis

Abstract

Background: Pulsed radiofrequency (PRF), as a new technique, is used to treat a variety of chronic pain syndromes, but it has a high recurrence rate for herpetic neuralgia and is often combined with drugs therapy. The aim of this study was to comprehensively evaluate the efficacy and safety of PRF combined with pregabalin in the treatment of herpetic neuralgia.

Methods: The electronic databases, including CNKI, Wanfang data, PubMed, Embase, web of science, and Cochrane Library were searched from inception to January 31, 2023. The outcomes were pain scores, sleep quality and side effects.

Results: Fifteen studies with 1817 patients were included in this meta-analysis. PRF combined with pregabalin significantly reduced the visual analogue scale/score in patients with postherpetic neuralgia or herpes zoster neuralgia when compared with pregabalin or PRF monotherapy [P < .00001, standardized mean difference (SMD) = -2.01, confidence intervals (CI) = -2.36 to -1.66; P < .00001, SMD = -0.69, CI = -0.77 to -0.61]. Compared with pregabalin monotherapy, PRF combined with pregabalin significantly decreased the pittsburgh sleep quality index score, the dosage and number of days of using pregabalin (P < .00001, SMD = -1.68, CI = -2.19 to -1.17; P < .00001, SMD = -0.94, CI = -1.25 to -0.64; P < .00001, SMD = -1.52, CI = -1.85 to -1.19). However, there was no significant difference in the effect of PRF combined with pregabalin versus PRF alone on pittsburgh sleep quality index score in patients with postherpetic neuralgia (P = .70, SMD = -1.02, CI = -6.11 to 4.07). In addition, PRF combined with pregabalin could significantly decrease the incidence of dizziness, somnolence, ataxia and pain at puncture site when compared with pregabalin monotherapy (P = .0007, odds ratio [OR] = 0.56, CI = 0.40 to 0.78; P = .008, OR = 0.60, CI = 0.41 to 0.88; P = .008, OR = 0.52, CI = 0.32 to 0.84; P = .0007, OR = 12.39, CI = 2.87 to 53.43), but no significant difference was observed when compared with PRF alone.

Conclusions: PRF combined with pregabalin can effectively alleviate the pain intensity and improve sleep quality in patients with herpetic neuralgia, and the incidence of complications was low, so it was worthy of clinical application.

Figure 1.

The flow diagram of study screening in this meta-analysis.

Figure 2.

The effect of PRF combined with pregabalin on VAS score for the treatment of patients with PHN. PHN = postherpetic neuralgia, PRF = pulsed radiofrequency, VAS = visual analogue scale/score.

Figure 3.

The effect of PRF combined with pregabalin on VAS score in patients with HZN. HZN = herpes zoster neuralgia, PRF = pulsed radiofrequency, VAS = visual analogue scale/score.

Figure 4.

The effect of PRF combined with pregabalin on PSQI score. PRF = pulsed radiofrequency, PSQI = pittsburgh sleep quality index.

Figure 5.

The effect of PRF combined with pregabalin on the dosage and number of days of using pregabalin in the treatment of patients with herpetic neuralgia. PRF = pulsed radiofrequency.

Figure 6.

The funnel plot in this meta-analysis.