Efficacy of high-voltage pulsed radiofrequency at the dorsal root ganglion combined with continuous epidural block on acute herpetic zoster pain and preventing postherpetic neuralgia in patients with acute herpes zoster

Abstract

Objective To evaluate the efficacy of high-voltage pulsed radiofrequency at the dorsal root ganglion combined with continuous epidural block on acute herpetic zoster pain and preventing postherpetic neuralgia in patients with acute phase of herpes zoster. Methods Fifty-seven patients with herpes zoster, from March 2016 to February 2018 in Second Affiliated Hospital of Xiamen Medical College and Fujian Provincial Hospital, were divided into two groups randomly: continuous epidural block group (29 cases) and combination treatment group (28 cases). Patients were received continuous epidural block combined drug therapy including tramadol, pregabalin and antiviral agents in the continuous epidural block group. While patients were received pulsed radiofrequency at the dorsal root ganglion additional to the combination treatment group. Numerical rating scale (NRS) was observed before the treatment and at 1 week, 1, 3 and 6 months after the treatment. The rate of patients received tramadol and pregabalin, the incidence of PHN were recorded at 1 week, 1 month, 3 months and 6 months after the treatment. Results Compared with pretreatment, NRS was significantly decreased in the two groups at each time point after the treatment (P<0.05). NRS was even significantly lower in the combination treatment group than that in the continuous epidural block group at 6 months after the treatment (P<0.05). Compared with the continuous epidural block group, the incidence of PHN was significantly decreased at 1, 3 months in the combination treatment group[7% (2/28 cases) vs. 31% (9/29 cases) , 0 vs. 14% (4/29 cases) ](P<0.05). Compared with the continuous epidural block group, the usage rate of pregabalin was significantly decreased at 1 week in the combination group (P<0.05). Conclusion High-voltage pulse radiofrequency at the dorsal root ganglion combined with continuous epidural block can effectively relieve the acute herpetic zoster pain and decrease the incidence of PHN in patients with acute herpes zoster. Key words: Ganglia, spinal; High-voltage; Pulsed radiofrequency treatment; Herpes zoster; Acute phase; Neuralgia, postherpetic