The Analysis Of Treatment Efficacy Of Short-Term Electrical Stimulation And Pulsed Radiofrequency For Trigeminal Zoster-Associated Neuralgia

BackgroundTrigeminal zoster-associated neuralgia(TZAN)is a skin lesion and nerve damage in the area of trigeminal innervation caused by reactivation of varicella-zoster virus(VZV)latent in the Gasserian ganglia.There is no expert consensus on the management of trigeminal zoster-associated neuralgia,and the main reference for its treatment is based on herpes zoster-associated neuralgia(ZAN).Neuromodulation therapy mainly includes short-term electrical stimulation(st-ES)and pulsed radiofrequency(PRF)therapy,which are widely used in the treatment of herpes zoster-associated neuralgia.However,there is a lack of comparative efficacy,safety analysis,and analysis of influencing factors of these two neuromodulation therapies in the treatment of TZAN.ObjectiveThis study aims to evaluate the clinical efficacy and safety of st-ES versus PRF in the treatment of TZAN and to analyze the risk factors affecting the treatment outcomes.MethodsThe clinical data of patients who attended the Pain Department of Shandong Provincial Hospital from January 2019 to May 2022 and received st-ES or PRF for TZAN were collected.Then,followed up and observed for their clinical efficacy.The clinical efficacy of st-ES and PRF for TZAN was compared after propensity score matching(PSM).And then according to whether the Gasserian ganglia was the treatment target,we compared the efficacy within the same treatment modality group.The Numerical Rating Scale(NRS),Pittsburgh sleep quality index(PSQI),mean pregabalin(mg/day)and gabapentin(g/day)dosage,hospitalization days and costs were evaluated.Subsequently,we judged whether the treatment was effective(effective=0,ineffective=1)based on whether the NRS decreased>50%at the end of follow-up compared with the NRS at the time of admission.We used Lasso regression to screen the variables such as general patient data,blood routine and blood biochemistry,and we screened the factors that might affect the efficacy.Then,we applied univariate and multifactor logistic regression analysi’s and established a prediction model,and used the C index,ROC(receiver operating characteristic)curve,area under the curve(AUC)to assess model accuracy,and clinical decision curve analysis(DCA)to assess model efficacy.Results1.A total of 61 patients were included,and 25 patients were included in each of the st-ES and PRF groups after propensity score matching.St-ES and PRF groups showed a significant reduction in the NRS,PSQI,mean dosage of pregabalin,and gabapentin after treatment compared with those at admission(P<0.05).2.St-ES and PRF groups were compared between groups,and the NRS,PSQI,mean dosage of pregabalin,and gabapentin at admission were not statistically significant between groups(P>0.05).And there were statistically significant differences between groups for NRS at discharge,1 month postoperatively,3 months postoperatively,and 6 months postoperatively(P<0.05),and no statistically significant differences between groups for PSQI,pregabalin,and gabapentin mean dosage at discharge,but significant differences between groups for PSQI,pregabalin,and gabapentin mean dosage at 6 months of follow-up(#P<0.05).The effective rate was 68%in the st-ES group and 40%in the PRF group,and the effective rate was significantly higher in the st-ES group than in the PRF group(#P<0.05).3.Within the st-ES group,there was no significant difference in NRS,PSQI as well as gabapentin(g/day)and pregabalin(mg/day)dosage at admission between the patients targeting Gasserian ganglia and those targeting the trigeminal branches(P>0.05),and there was a significant difference in NRS at 1 month and 6-month postoperative follow-up(P<0.05).PSQI and mean dosage of gabapentin(g/day)at discharge and at 6-month follow-up were not significantly different(P>0.05),while pregabalin(mg/day)dosage was significantly different at 6-month postoperative follow-up(P<0.05).4.Within the PRF group,there was no significant difference in the NRS of patients with different targets at admission(baseline NRS),preoperatively,at discharge,1 month postoperatively,and 3 months postoperatively after PRF was given at different treatment targets(P>0.05),but the NRS scores were significantly lower in patients treated with Gasserian ganglia targets than in patients treated with trigeminal branch targets at 6-month follow-up(P<0.05).PSQI,gabapentin(g/day)and pregabalin(mg/day)dosage were not significantly different at admission,at discharge and at follow-up(P>0.05).5.The LASSO regression screened 8 variables(gender,disease duration,treatment target,treatment modality,NRS at admission,white blood cells number,lymphocyte number,and low-density lipoprotein cholesterol).The model was built by logistic regression analysis,In(p/1-p)=-16.5+1.421*sex+1.346*:course of TZAN+4.306*treatment therapy+3.226*treatment target-0.611*WBC+0.986*LDL-C.The results of logistic regression suggested that long duration of disease,treatment target(semilunar ganglion=1,trigeminal branches=2),treatment modality(st-ES=1,PRF=2),and reduced WBC were the variables affecting the treatment outcomes of ZAN(P<0.05).6.The calculated C index was 0.928 and the area under the ROC curve was 0.928(95%CI:0.862-0.994),indicating the good predictive performance of the model.The calibration curves showed a high overlap between the ideal and calibration curves,suggesting a high calibration of the model.The clinical utility of the model was evaluated using decision curve analysis(DCA),with the threshold probability in the horizontal coordinate and the net benefit in the vertical coordinate,and the clinical net benefit was greater than 0 when the prediction probability was greater than 0.03,and the model could obtain clinical benefit.Conclusions1.St-ES and PRF can both significantly relieve the pain in TZAN patients,but st-ES is more efficacious than PRF.The mean number of hospitalization days and costs were higher in the st-ES group than in the PRF group.The percentage of numbness in the herpetic pain area occurred after surgery was higher in the PRF group than in the st-ES group.2.The treatment of TZAN by targeting the Gasserian ganglia was superior to that by targeting the trigeminal nerve branches when same treatment modality was applied.3.The duration of disease,treatment modality,treatment targets,and white blood cells(WBC)are all factors affecting treatment outcomes of TZAN.