A central and peripheral dual neuromodulation strategy in pain management of zoster-associated pain

Abstract

Spinal cord stimulation (SCS) has shown effectiveness in relieving zoster-associated pain (ZAP), but some patients still experience moderate or severe pain after SCS treatment. This study aims to evaluate the impact of SCS combined with dorsal root ganglion (DRG) pulsed radiofrequency (PRF) as a dual neuromodulation strategy on the prognosis of ZAP. The clinical records of patients diagnosed with ZAP who underwent SCS (SCS group) or SCS combined with PRF (SCS + PRF group) at The Third Xiangya Hospital, Central South University, were retrospectively analyzed to compare the effectiveness of the two treatment approaches for ZAP. Outcome measures included changes in Visual Analog Scale (VAS) scores before and after neuromodulation treatment, response rates, and incidence of progression to postherpetic neuralgia (PHN).13 SCS patients and 15 SCS + PRF patients were analyzed. Admission VAS scores were similar (P = 0.934). Upon discharge, no significant differences in VAS or response rates were observed (P > 0.05). However, at 6-month follow-up, the SCS + PRF group had lower VAS scores (1.53 ± 1.06 vs. 3.23 ± 1.50, P < 0.001) and a lower proportion of residual moderate pain (P = 0.041). None in the SCS + PRF group progressed to PHN in the acute/subacute phases, differing significantly from the SCS group (P = 0.038).Therefore, SCS combined with DRG PRF is feasible and effective in the treatment of ZAP. This dual neuromodulation strategy may be a more appropriate regimen for the treatment of ZAP.

Keywords: Neuromodulation; Pulsed radiofrequency; Spinal cord stimulation; Zoster-associated pain.

Fig. 1

PRF cannulas were accurately located in the intervertebral foramens confirmed by the guidance of C-arm fluoroscopy. (a) Anterior-posterior. (b) lateral view.

Fig. 2

Flow diagram for patient selection.

Fig. 3

6 months postoperation, the proportion of patients with different degrees of pain in the two groups was compared. (a) 6 months postoperation, 38.46% of the patients in the SCS group had moderate pain. (b)6 months postoperation, 6.67% of the patients in the SCS + PRF group had moderate pain. χ2 test, P = 0.041.

Fig. 4

Analysis of the therapeutic effects of patients with acute and subacute in ZAP. (a) Changes of VAS scores at baseline, discharge and 6 months postoperative in Non-PHN patients.Two-way analysis of variance with repeated measures and post-hocmultiple pairwise comparison Sidak’s testing was used to assess the alteration of pain scores between two groups over time.***P<0.001. (b) Numbers of Non-PHN progressing to PHN at 6 months postoperative.χ2 test, P = 0.038.