Cai Shihong, Du Li, Xiang Xiaoming, Liu Chengjiang, Zhang Yanfeng, Peng Zhiyou, Kang Xianhui, Feng Zhiying
Department of Pain Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Pain Medicine, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, China.
Heliyon. 2024 May 6;10(9):e30525. doi: 10.1016/j.heliyon.2024.e30525. eCollection 2024 May 15.
Postherpetic neuralgia (PHN) is one of the most common and serious complications of herpes zoster infection. Pulsed radiofrequency (PRF) therapy has emerged to be a neuromodulation technique for the treatment of PHN. Two therapeutic options are available for PRF, including high-voltage and standard-voltage PRF. Some studies suggested that the former one had better clinical efficacy than the latter one. For the first time, this pooled analysis compared the efficacy and safety of these two surgeries for the treatment of PHN. Five commonly used databases were applied to identify the eligible studies. This study was registered on the PROSPERO (ID: CRD42023460236), which provided more relevant information. Finally, four randomized controlled trials (RCTs) with 285 participants were included. The combined odds ratios (OR) showed that high-voltage PRF exhibited a significantly higher treatment efficiency than the standard PRF (OR = 1.4, 95%CI: 1.16 to 1.69, P < 0.001). Additionally, the visual analogue scale (VAS) in the high-voltage PRF group was significantly lower than that of the standard PRF group at one week (SMD = -0.776, 95%CI: -1.408 to -0.145, P = 0.016), one month (SMD = -0.544, 95%CI: -0.907 to -0.180, P = 0.003), and three months (SMD = -1.096, 95%CI: -1.504 to -0.687, P < 0.001) after treatment, particularly at the three months after surgery. However, the VAS was comparable between the two groups (SMD = -0.94, 95%CI: -1.985 to 0.104, P = 0.077). Patients who underwent high-voltage PRF did not have a significantly higher incidence of adverse events than those with standard PRF (OR = 1.56, 95%CI: 0.78 to 3.13, P = 0.208). In summary, the current study revealed that high-voltage PRF is superior to standard-voltage PRF in improving analgesic efficacy in patients with PHN. Additionally, it does not increase the incidence of treatment-related adverse effects. Further studies are still warranted to determine the optimal voltage and duration of PRF treatment for patients with PHN.
带状疱疹后神经痛（PHN）是带状疱疹感染最常见且最严重的并发症之一。脉冲射频（PRF）治疗已成为一种用于治疗PHN的神经调节技术。PRF有两种治疗选择，包括高压PRF和标准电压PRF。一些研究表明，前者的临床疗效优于后者。本荟萃分析首次比较了这两种手术治疗PHN的疗效和安全性。应用五个常用数据库来识别符合条件的研究。本研究已在国际前瞻性注册系统（PROSPERO，注册号：CRD42023460236）上注册，该系统提供了更多相关信息。最后，纳入了四项随机对照试验（RCT），共285名参与者。合并比值比（OR）显示，高压PRF的治疗效率显著高于标准PRF（OR = 1.4，95%CI：1.16至1.69，P < 0.001）。此外，在治疗后1周（标准化均数差[SMD] = -0.776，95%CI：-1.408至-0.145，P = 0.016）、1个月（SMD = -0.544，95%CI：-0.907至-0.180，P = 0.003）和3个月（SMD = -1.096，95%CI：-1.504至-0.687，P < 0.001）时，高压PRF组的视觉模拟评分（VAS）显著低于标准PRF组，尤其是在术后3个月时。然而，两组之间的VAS相当（SMD = -0.94，95%CI：-1.985至0.104，P = 0.077）。接受高压PRF治疗的患者不良事件发生率并不显著高于接受标准PRF治疗的患者（OR = 1.56，95%CI：0.78至3.13，P = 0.208）。总之，当前研究表明，在改善PHN患者的镇痛效果方面，高压PRF优于标准电压PRF。此外，它不会增加治疗相关不良反应的发生率。仍有必要进行进一步研究以确定PHN患者PRF治疗的最佳电压和持续时间。
