The 321 Strategy for Treating Different Phases of Herpetic Neuralgia With Two Stimulation Modes

Abstract

Background: Older individuals are at high risk for herpetic-related neuralgia, and aging significantly increases the likelihood of postherpetic neuralgia (PHN). Although spinal cord stimulation has shown promise in treating chronic intractable neuralgia, the comparative efficacy of tonic and burst stimulation modes in treating herpetic neuralgia through short-term spinal cord stimulation (st-SCS) remains unclear. In addition, the optimization of procedural strategies has rarely been reported.

Objectives: This study aims to compare the efficacy of tonic and burst stimulation in treating herpetic neuralgia and establish a "321 strategy" for facilitating rapid recovery and preventing PHN.

Materials and methods: From January 2023 to June 2024, 94 patients (31 with acute herpetic neuralgia, 46 with subacute herpetic neuralgia, and 17 with PHN) whose pharmacologic and interventional treatments failed underwent st-SCS therapy with tonic or burst stimulation for 14 days. The visual analog scale (VAS) score and Pittsburgh Sleep Quality Index score were recorded at various intervals.

Results: No significant differences were found between the tonic and burst stimulation modes in reducing the VAS score for acute herpetic neuralgia, subacute herpetic neuralgia, or PHN (p > 0.05). At the six-month follow-up, st-SCS effectively reduced the incidence of PHN, with significant pain relief in most patients.

Conclusions: The 321 strategy under both stimulation modes can effectively alleviate herpetic neuralgia, promote rapid recovery, and reduce PHN incidence, indicating its potential as a promising therapeutic approach for herpetic neuralgia.

Keywords: 321 strategy; herpetic neuralgia; postherpetic neuralgia; short-term spinal cord stimulation.