CLINICAL STUDY OF SPINAL CORD STIMULATION AND PULSED RADIOFREQUENCY FOR MANAGEMENT OF HERPES ZOSTER-RELATED PAIN PERSISTING BEYOND ACUTE PHASE IN ELDERLY PATIENTS

Authors: Liu B, Yang Y, Zhang Z, Wang H, Fan B and Sima L.
Study type: Prospective, randomized-controlled clinical trial
Publication: Pain Physician 2020; 23(3):263-270 (Link to PubMed)
Key Words: Post Herpetic Neuralgia – Dorsal Root Ganglion –Pulsed RF vs Spinal Cord Stimulation

Graph created by Boston Scientific based on the published data

STUDY GOAL

To assess the efficacy of Spinal Cord Stimulation (SCS) and Pulsed Radiofrequency (PRF) in the treatment of herpes zoster-related pain persisting beyond the acute phase (i.e., post-herpetic neuralgia) in elderly patients.

METHODOLOGY

Patients: 63 patients aged over 50 years with herpes zoster (HZ) pain persisting for 20 to 180 days were selected and randomized to receive either SCS (N=31) or PRF (N=32).
The following outcomes were measured: Numeric Rating Scale (NRS-11) score, response rate (pain relief ≥50%), complete remission rate (pain score ≤ 3), and analgesics intake reduction.

SCS procedure: SCS electrodes were placed in the affected spinal ganglion under fluoroscopy-guidance. Patients received SCS for two weeks (electrodes were removed after treatment) SCS parameters: Voltage 1-3 V; 1 Pulse width (PW) 20-210 ms; Frequency 30-60 Hz.

PRF procedure: The affected DRG was punctured with the RF needle under fluoroscopy guidance. A sensory test (50Hz and 0.3-06 V) was performed to confirm needle position and pain coverage. PRF treatment was performed with a Cosman G4 instrument.

PRF parameters: 40-60V; 20ms PW; 2Hz for 360 seconds. Electrode tip: 42°C.

RESULTS

  • Pain scores in both SCS and RPF groups decreased significantly after surgery and at 1,4,12 and 24 weeks follow-up, compared to baseline score (p<0.001).
  • No significant difference was found between the SCS and PRF groups
  • The effective rate of pain treatment, for both groups, was in the range of 57% to 81%, and the complete pain relief rate ranged from 37% to 71%. 
  • The number of patients who used analgesics and calcium channel antagonists decreased dramatically for both treatment groups (p < .001)
NRS-11 scores pre- and 1, 4, 12. and 24 weeks post-operation image
Postoperative efficiency rates image
Complete remission rates image
A. NRS-11 scores pre- and 1, 4, 12. and 24 weeks post-operation. The NRS-11 score in the SCS group decreased to 2.90 ± 1.83 (1W) and 4.37 ± 2.43 (24W), while that in the PRF group decreased to 3.13 ± 1.78 and 4.23 ± 2.64, respectively (compared with baseline) B. Postoperative efficiency rates (pain relief ≥50%). C. Complete remission rates (pain score ≤ 3).

AUTHOR’S CONCLUSION

To a similar extent, SCS and PRF treatments can effectively improve post-herpetic neuralgia in elderly patients.

Top