Efficacy Analysis Of Two Neuromodulation Approaches For Herpes Zoster-associated Neuralgia Based On Propensity Score Matching

BackgroundHerpes zoster-associated pain(ZAP)is a form of neuropathic pain usually confined to the herpes area and is mainly characterized by electric shocks,burning,or cutting-like persistent pain with or without touch-evoked pain.Currently,clinical specialized treatment options for herpes zoster-associated neuralgia are lacking,medication provides incomplete pain relief,some patients have difficulty tolerating the side effects of medicine.In addition,medication is ineffective in 20-40%of patients.Pulsed Radiofrequency(PRF)and short-term Nerve Electrical Stimulation(st-NES)are effective treatments for herpes zoster-associated pain.Each modality has its benefits and drawbacks,yet,there is a lack of high-quality evidence comparing the efficacy of the two treatment modalities.It remains unclear which technique provides better analgesia in treating herpes zoster-associated neuralgia.Furthermore,previous studies comparing the efficacy of pulsed radiofrequency and short-course electrical nerve stimulation in ZAP have yielded inconsistent results.ObjectiveIn this study,we intend to collect patients who received PRF and st-NES in our hospital during the same period for follow-up observation.Then the long-term and short-term efficacy and safety of the two treatment modalities are compared by analyzing the targeted observation indexes,aiming to provide a more valuable reference for the selection of clinical treatment options for ZAP.MethodsAll eligible patients with ZAP who had received st-NES or PRF in our department were included.Patients were followed up for the Numerical Rating Scale(NRS)scores,the Pittsburgh Sleep Quality Index(PSQI),complications,and medication dosages at 1,3,6,12,and 24 months postoperatively.The differences in the baseline characteristics between the two groups were balanced with the Propensity Score Matching(PSM),and the data from the followup were analyzed using SPSS.Finally,the Ordinal Logistic Regression analysis was performed to determine the factors affecting the efficacy of ZAP.ResultsA total of 254 patients were included,113 patients in each group after PSM.The postoperative NRS scores in the st-NES and PRF groups were significantly lower than the preoperative scores(P<0.05).At discharge,1,3,6,12,and 24 months,the NRS scores in the st-NES group were significantly lower than those in the PRF group(P<0.05).At least 55%of patients in the st-NES group had an NRS score less than three after surgery,while no more than 50%of patients in the PRF group had an NRS score below three.The percentage of patients with an excellent outcome was 28%-43%in the st-NES group and 9%-22%in the PRF group(P<0.05).For AHN or SHN,the NRS scores in the st-NES group were prominently lower than those in the PRF group at discharge,1,3,and 6 months after surgery(P<0.05).For PHN,the NRS scores in the st-NES group were remarkably lower than those in the PRF group at any time interval after surgery(P<0.05).In the cranial dermatome,the NRS scores in the st-NES group were significantly lower than those in the PRF group at discharge,1,3,and 6 months(P<0.05).In cervical and thoracic dermatome,the NRS scores in the st-NES group were significantly lower than those in the PRF group at any time interval(P<0.05).There was no significant difference between the two groups in the lumbosacral dermatome.The medication dosages in both groups after surgery were less than those before surgery(P<0.05),and there was no significant difference between the two groups(P>0.05).The st-NES group had significantly lower post-discharge PSQI scores than the PRF group(P<0.05)and significantly fewer patients with worsening pain after discharge than the PRF group(P<0.05).Disease duration and treatment modality are the final influencing factors on the efficacy of ZAP.ConclusionsPRF and st-NES have fewer complications,obviously relieving pain and improving sleep quality for ZAP patients.PRF and st-NES are safe and effective treatment options for ZAP,while st-NES has superior efficacy.For AHN and SHN,the efficacy of st-NES is better than that of PRF within 12 months after surgery,and there is no difference between the efficacy of st-NES and PRF after 12 months.In ZAP of the cranial dermatome,st-NES is more effective than PRF within six months,and the efficacy between st-NES and PRF has no difference after six months.However,there is no significant difference in the short-and long-term efficacy of st-NES and PRF when the target nerve is the gasserian ganglion.In ZAP of the cervical and thoracic dermatome,the long-and short-term efficacy of st-NES is superior to PRF.In ZAP of the lumbosacral dermatome,there was no significant difference in therapeutic efficacy between the two methods.