The Effectiveness Of Pulsed Radiofrequency Therapy In The Treatment Of Post Herpetic Neuralgia And Influencing Factors

Objective:To investigate the immediate-term and 6-month-term effects on the treatment of pulsed radiofrequency in postherpetic neuralgia.Method:A retrospective analysis was performed on 79 patients with post-herpetic neuralgia in the pain department of Shandong provincial hospital from January 2014 to June 2017.General information,pain score,sleep quality and duration of medication were obtained through patient data and telephone follow-up.The pain scores before and after treatment were analyzed by Wilcoxon test.The differences in NRS scores of different parts were also analyzed by Wilcoxon test.The 6-month-term remission rate was calculated.Independent sample t test,man-whitney,chi-squareor Fisher's test was used to analyze the differences of patients' age,gender,course of disease,pain intensity,treatment site,diabetes,continuous medication,PRF temperature and time on remission rate.Logistic regression was used to analyze the factors affecting the remission rate of patients with PHN.Results:62 patients were followed up successfully among 79 patients.They all had a remission in immediate-term and 6-month-term pain.after PRF treatment.Test results suggested that age,gender,initial pain level,treatment site,diabetes,radiofrequency temperature,pulsed duration,voltage and continuous medication had no difference in different remission rates(P>0.05).The duration of the disease was different between different remission rates(P>0.05).Multivariate logistic regression analysis found that the duration and consistent medication had an effect on the remission rate of PHN after PRF treatment.The more than 6-months duration of PHN was a risk factor for the remission rate of 50%or more,and continued medication was a favorable factor for the remission rate of 50%.In all patients,only one patient had postoperative nausea and vomiting syptoms after PRF treatment.Conclusion:1.There are clinical effects of pulsed radiofrequency therapy on post herpetic neurglnia in both short-term and long-term,which is safe and effective.2.The pain can be alleviated to a certain extent after pulsed radiofrequency treatment in different parts of post herpetic neuralgia.3.Age,gender,initial pain level,treatment site,diabetes,radiofrequency temperature,and pulsed duration are not the factors that influence the greater remission rate of pulse radiofrequency regulation in the treatment of neuralgia after herpes zoster.4.Patients with neuralgia after herpes zoster should be treated with pulse radiofrequency regulation early,which is good for pain relief.The six months efficacy of pulse radiofrequency therapy may be consolidated with adjuvant therapy of analgesics.BackgroundRadicular pain is the most common clinical symptom of lumbar intervertebral disc herniation,and the pain is severe,which has impact on patient's work and life.Recently,studies have shown that except the mechanical compression factors of nucleus ulposus,the immune inflammatory response induced by the nucleus pulposus is also an important mechanism of root neuralgia.Resolvin is a new type of pro-resolving mediators,while resolvin D2(RvD2)is a new member of the family.Studies have shown that RvD2 not only has a significant anti-inflammatory effect in the inflammatory disease models,but also has good anti-inflammatory and analgesic effects in acute and chronic inflammatory pain models.The purpose of this study is to explore the role and potential mechanism of RvD2 in the non-compressive intervertebral disc,which will provide basic experimental basis for the treatment of root neuralgia.ObjectiveTo explore the role and potential mechanism of resolvin D2(RvD2)on the radicular pain in rat models of non-compressive lumbar intervertebral disc herniation.Methods1.Rat models of non-compressive intervertebral disc herniationv were extablished,and a continuous treatment of RvD2 or PBS for 3 days were given after operation.Rats were divided 4 groups:sham group(n=12),treatment with lOul saline intrathecally;vehicle group(n=12),treatment with 10ul PBS and lOul saline intrathecally;10ng group(n=12),treatment with 10ng/lOul RvD2 and lOul saline intrathecally;100ng group(n=12),treatment with 100ng/lOul RvD2 and 10ul saline intrathecally.2.The mechanical pain thresholds were detected 1d before surgery and continous 7 days after surgery.7d after surgery,dorsal horn of the spinal cord was obtained.Real time PCR and ELISA were used to detect the inflammatory cytokines in the spinal cord.Western blot detects the Akt/GSK-3(3 signaling pathway in spinal dorsal horn.The expression of RvD2 receptor,GPR18,in the dorsal horn of spinal cord and its specific expression in nerve cells were detected by double immunofluorescence.Results1.The mechanical pain threshold was significantly reduced after surgery,and the pain sensitivity of rats was significantly increased after different doses of RvD2 treatment;2.The expression levels of pro-inflammatory cytokines were increased and the expression level of anti-inflammatory mediator decreased in vehicle group.The expression level of TNF-a and IL-6 decreased,and the expression level of anti-inflammatory cytokine TGF-?1 increased after RvD2 treatment.3.The activity of GKS-3? signaling was reduced after the different doses of RvD2 treatment;4.GPR18 expression was increased in the dorsal horn,and it was specifically expressed in neurons and astrocytes of spinal dorsal horn.ConcludesThe mechanical pain threshold of rat models was alleviated by RvD2.The receptor of RvD2 was specially expressed on neurons and astrocytes.The mechanisms of pain relief may be related with the regulating Akt/GSK-3? signaling,and the decreased pro-inflammaroty cytokines and increased anti-inflammatory cytokines.This study provided a new experimental evidence for radicular pain.