| Objective: To analyze and compare the efficacy of short-term peripheral nerve stimulation(SCS),short-term spinal cord stimulation(PNS),and trigeminal nerve gasserian ganglion pulse radiofrequency(PRF)therapy on herpes zoster induced trigeminal neuralgia,and to explore the possible factors affecting the treatment effect and the incidence of PHN of such patients.Methods: 56 patients with herpes zoster associated neuralgia were selected and divided into short-term peripheral nerve stimulation group(PNS group,24 cases)and short-term temporary spinal cord stimulation group(SCS group,14 cases)and gasserian ganglion PRF group(PRF group,18 cases)according to different treatment methods.Visual analogue scale(VAS)was used to evaluate the degree of pain before and after the first,fourth and twelfth weeks of surgery.The number of breakthrough pain(BTP)was used to record the number of daily pain outbreaks before and after the first,fourth and twelfth weeks of surgery.The anxiety and depression of the patients were evaluated by Hospital Anxiety and Depression Scale(HADS).And the quality of life was assessed with the Brief Pain Inventory(BPI),and the daily dose of tramadol and pregabalin was recorded at each time point before and after operation.The effects of ages and preoperative pain levels(VAS score)on the treatment effects of the patients were observed and the correlations between these factors and the treatment effects were analyzed too.Results:1.Compared with the preoperative period,the VAS scores of the three groups of patients were lower at all time points,and the difference was statistically significant(P <0.05);The VAS scores of the three groups were lower at the first week after the operation,however,there was no significantly statistical difference in the VAS scores of the three groups(P > 0.05);The VAS scores of PNS and SCS groups at the 4th and 12 th week after surgery were lower than those of PRF group,the differences were statistically significant(P < 0.05);The VAS scores of patients between PNS group and SCS group were similar and the difference was not statistically significant(P > 0.05).2.The number of daily BTP in the three groups of patients was lower at each time point after operation,and the differences were statistically significant compared with those before the operation(P < 0.05);Between PNS group and PRF group,and between SCS group and the PRF group,at the 1st,4th,and 12 th weeks after the operation,there were statistically significant differences in BTP(P < 0.05);There was no significant difference of BTP between the PNS group and the SCS group(P > 0.05).3.The BPI scores of the three groups of patients were lower at each time point after operation,and the difference was statistically significant compared with those before the operation(P < 0.05);At the 1st,4th,and 12 th weeks after surgery,the BPI differences were statistically significant between PNS group and PRF group or between SCS group and PRF group(P < 0.05);No difference was found between the PNS group and the SCS group(P > 0.05).4.The scores of the anxiety part of HADS(HADS-A)and the depression part of HADS(HADS-D)in the three groups of patients were reduced one week after operation,and the difference was statistically significant(P < 0.05).The scores of HADS-A and HADS-D in the PRF group at 4th and 12 th week postoperatively were not significantly different from those before surgery(P > 0.05).Compared with the HADS scores of the preoperative,those of PNS and SCS groups were lower at the 4th and 12 th weeks postoperatively and the differences was statistically significant(P < 0.05);The HADS scores of PNS group and SCS group were lower compared with those of PRF group at the1 st,4th,and 12 th week after the operation and there were significant differences(P <0.05);There was no statistically significant difference in HADS score between PNS group and SCS group at week 1,week 4,and week 12 after surgery(P > 0.05).5.The dosage of tramadol in the first week after operation in the three groups was lower than that before operation,and the difference was statistically significant(P < 0.05).There was no statistically significant difference in the dosage of tramadol between 12 weeks after operation and the preoperative in the PRF group(P > 0.05).The dosage of tramadol 4 weeks and 12 weeks after operation in PNS and SCS groups was lower than that of PRF group,and and the difference was statistically significant(P < 0.05),but no significant difference was found in the dosage of tramadol between PNS group and SCS group(P > 0.05).6.The dosage of pregabalin in the first week after operation in the three groups was lower than that before operation,and the difference was statistically significant(P < 0.05).There was no statistically significant difference in the dosage of pregabalin between 12 weeks after operation and the preoperative in the PRF group(P > 0.05).The dosage of pregabalin 4 weeks and 12 weeks after operation in PNS and SCS groups was lower than that of PRF group,and and the difference was statistically significant(P < 0.05),but no significant difference was found in the dosage of pregabalin between PNS group and SCS group(P > 0.05).7.The incidence rate of postherpetic neuralgia(PHN)in the PNS group was 5/24(20.8%);The incidence rate of PHN in 20 patients in the SCS group was 4/14(28.6%);The incidence rate of PHN in 10 patients in the PRF group was 10/18(55.6%).The incidence of PHN in PNS group was significantly higher than that in PRF group(P <0.05);The incidence of PHN in SCS group was significantly higher than that in PRF group(P < 0.05);There was no significant difference in PHN between PNS group and SCS group(P > 0.05).8.At the 12th week after surgery,the efficacy of the low-age group was better than that of the high-age group,the difference was statistically significant(P < 0.05);The effect of the moderate pain group was better than the severe pain group,the difference was statistically significant(P < 0.05).9.The incidence of postoperative PHN in high-age patients was higher than that in low-age patients,the difference was statistically significant(P <0.05);The incidence of postoperative PHN was higher in patients with severe pain than in patients with moderate pain,and the difference was statistically significant(P <0.05).10.There were no postoperative complications and adverse reactions in 56 patients,such as cerebrospinal fluid leakage,infection,limb weakness and electrode shift.Conclusions:1.From the short-term efficacy(1 week after surgery),short-term PNS,short-term SCS,and trigeminal nerve gasserian ganglion PRF can all improve patients’ pain and quality of life.However,the long-term effects of PNS and SCS were significantly better than PRF(4 weeks and 12 weeks after surgery),and SCS and PNS can not only effectively reduce the pain of patients with herpes zoster trigeminal neuralgia,but also improve the state of anxiety and depression,and reduce the use of tramadol and pregabalin;There was no significant difference of treatment efficacy between PNS and SCS.2.Both short-term PNS and short-term SCS can significantly reduce the incidence of PHN.3.The treatment efficacy of low-age patients is better than that of high-age patients,and the treatment efficacy of patients with moderate pain is better than that of severe pain.4.Patients with high age(>70 years)or severe preoperative pain(VAS ≥ 7 points)have a higher incidence of postoperative PHN. |
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