Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Education and Training Hospital, Istanbul, Turkey

Background: Postherpetic neuralgia (PHN) occurs in 9% to 34% of herpes zoster (HZ) patients,and the incidence of PHN is positively correlated with age. A number of patients suffer from poortherapeutic effects or intolerable side effects and need to accept minimally invasive analgesia.Objectives: This study aimed to investigate the effects of spinal cord stimulation (SCS) andpulsed radiofrequency (PRF) on the treatment of elderly patients with HZ-related pain persistingbeyond the acute phase.Study Design: A prospective, randomized-controlled trial.Setting: Research was conducted at the National Pain Management and Research Center, ChinaJapan Friendship Hospital (Beijing, China).Methods: We selected 63 patients aged over 50 years with zoster-related pain of 1 to 6 monthsonset. They were randomly divided into an SCS group and a PRF group. In the SCS group, thestimulus electrodes were placed in the affected spinal ganglion segment of the epidural space for 2weeks. In the PRF group, the radiofrequency needle was percutaneously punctured in the affecteddorsal root ganglion. The main outcome measures were the Numeric Rating Scale (NRS-11) score,response rate, and complete remission rate. The secondary endpoint was defined as the use ofanalgesics and calcium channel antagonists.Results: The NRS-11 score in the SCS group decreased to 2.90 ± 1.83 (1 week post operation)and 4.37 ± 2.43 (24 weeks post operation), while that in the PRF group decreased to 3.13 ±1.78 and 4.23 ± 2.64, respectively (compared with baseline, P < .001); there was no significantdifference between the 2 groups (P > .05) . The effective rate of pain management was in therange of 56.67% to 81.25%, and the complete pain relief rate ranged from 37% to 71%. Thenumber of patients still using analgesics and calcium channel antagonists after operation weresignificantly less than those pre-operation (P < .001). Univariate and multivariate logistic regressionanalyses showed that the operation method, age, gender, and course of disease did not affectsurgical efficacy.Limitations: The main limitation of this study is that all the cases were from the same center.Conclusion: It therefore can be concluded that SCS and PRF can effectively relieve PHN.Key words: Spinal cord stimulation, pulsed radiofrequency, postherpetic neuralgia