Clinical Study On Radiofrequency Treatment Of Herpetic Neuralgia

Part Ⅰ Retrospective study on the clinical effect and influence factors of radiofrequency thermocoagulation for treating intractable postherpetic neuralgia at thorax and abdomenObjective To determine the efficacy and complications,analyze the influencing factors,and predict the efficacy of radiofrequency thermocoagulation(RFT)for treating intractable postherpetic neuralgia(PHN)at thorax and abdomenMethods A retrospective study was conducted on 109 patients with intractable PHN at thorax and abdomen,who were admitted to the Department of Pain Treatment in Affiliated Hospital of Jiaxing College from June 2013 to September 2018.All patients received CT-guided RFT at dorsal root ganglion(DRG).To evaluate the efficacy,numerical rating scale(NRS),gabapentin usages,Oxycodone usages and patient global impression of change(PGIC)were compared before and after the operation.Complications were also recorded.The effective criterion was NRS decreased ≥50% from the preoperative baseline at 1 year after the operation,which was used to analyze the independent influencing factors of RFT by univariate and multivariate logistic regression.Based on the results,R software was used to construct the nomogram which would be verified internally to predict the efficacy of RFT.Results Compared with pre-operation,NRS,usages of gabapentin and Oxycodone and PGIC decreased at 1,3,6 and 12 months after the operation.Differences were statistically significant(P < 0.05).At 1 year after the operation,the number of valid patients were 68 and the invalid were 41,Numbness was present in 105 patients and local abdominal distention was present in 16 patients.Univariate logistic regression showed that age,course of disease,neuromodulation therapy history and bipolar radiofrequency were statistical significance(P < 0.05).Multivariate logistic regression revealed that age > 65y(OR=0.234,95%CI: 0.078~0.703),disease course > 3m(OR=0.382,95%CI: 0.016~0.908)and bipolar radiofrequency(OR=5.727,95%CI: 1.437~22.827)were independent factors.Internal validation showed that the efficacy prediction model of RFT treatment of PHN had good discrimination(area under receiver operating curve was 0.725)and calibration(Hosmer-Lemeshow test,P=0.937).Conclusion For the elderly patients(> 65 years old)or patients with a long course of disease(>3 months),the effect of RFT is poor.Bipolar radiofrequency can further improve the effect of RFT treatment.Part Ⅱ Prospective study of pulsed radiofrequency combined with intravenous lidocaine for treating herpetic neuralgiaObjective To explore the efficacy of pulsed radiofrequency(PRF)combined with intravenous lidocaine for treating herpetic neuralgia(HN)and research its influence on Sensory nerve function,metalloproteinase-9 and aquaporin-4.Methods A prospective study was conducted on 42 patients with HN,who were admitted to the Department of Pain Medical Center in Affiliated Hospital of Jiaxing College from August 2019 to July 2020.They were assigned to group P and group PL randomly.Group P received pulse radiofrequency as group PL received pulsed radiofrequency combined with intravenous lidocaine.Numerical rating scale S(NRS),gabapentin usages,Oxycodone usages,nerve block times,current perception threshold(CPT),pain tolerance threshold(PTT),matrix metalloproteinases-9(MMP9)and water channel protein-4(AQP4)was compared between two groups.Results Compared with pre-operation,NRS,gabapentin and oxycodone usages decreased at 1d,2w,1m,3m of post-operation,while CPT and PTT increased at 1d of post-operation in two groups.Compared with group P,NRS decreased at post-operation,CPT and PTT increased at 1d of post-operation,while gabapentin usages and total number of nerve blocks decreased at 3m of post-operation in group PL.The difference was statistically significant(P<0.05).The difference of MMP9 and AQP4 between two groups was on statistically significant.Three patients in the PL group developed mild dizziness and fatigue,and no serious adverse reactions occurred.Conclusion Pulsed radio frequency combined with intravenous lidocaine for treating herpetic neuralgia is safe and effective,worthy of clinical reference.