Wang Jiang-Lin, Li Hai-Li, Liu Xiang-Bo, Zhao Jia-Gui, Huang Dong, Wu Cheng, Wang Jia-Shuang, Chen Jun
Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
Institute for Biomedical Sciences of Pain, Tangdu Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, China.
Front Neurol. 2025 May 19;16:1602689. doi: 10.3389/fneur.2025.1602689. eCollection 2025.
Chronic intractable postherpetic neuralgia (PHN) is a significant sequel of herpes zoster and significantly impacts patients' quality of life. Although some pharmacotherapies, interventional approaches, and neural modulation have been recommended as clinical options, their efficacy is limited. Here, we reported the efficacy and safety of a standardized therapeutic approach with CT-guided intervertebral foramen injection of ozone (IVFO) in patients with chronic intractable thoracic and lumbar (PHN) ( = 56) who had been tolerant or insensitive to first-line drugs, such as gabapentin (GBP) or pregabalin.
Visual analogue scale (VAS), quantitative sensory testing (von Frey filaments only), and infrared thermography were used to identify and quantify the pain intensity, area of mechanical hyperalgesia, and skin temperature in the included patients with PHN before and after IVFO treatment. Moreover, the dosage of and the time to discontinue GBP and complications were also documented after discharge from hospitals.
In this 1 year follow-up study, the primary endpoint outcomes measured by VAS showed that IVFO treatment resulted in significant relief of spontaneous pain by 59.19% [2.67 ± 0.66] for immediate, 68.18% [2.08 ± 0.89] for half year and 70.79% [1.91 ± 1.19] for 1 year after discharge vs. admission, dramatic decrease in spatial area of mechanical hyperalgesia by 52.35% [3.11 ± 0.70] for immediate and 87.41% [0.82 ± 0.50] for half year after discharge vs. admission and skin temperatures by 63.01% [0.85 ± 0.35] for immediate after discharge vs. admission. Moreover, half of the patients stopped taking GBP 3 months after discharge. No serious complications were reported during the one-year follow-up after IVFO treatment.
These results suggest that CT-guided IVFO treatment is a safe and effective interventional approach for the relief of chronic, drug-resistant, thoracic and lumbar PHN.
慢性顽固性带状疱疹后神经痛（PHN）是带状疱疹的一种严重后遗症，对患者的生活质量有显著影响。尽管一些药物治疗、介入方法和神经调制已被推荐为临床选择，但其疗效有限。在此，我们报告了一种标准化治疗方法的疗效和安全性，该方法为CT引导下经椎间孔注射臭氧（IVFO），用于治疗56例对加巴喷丁（GBP）或普瑞巴林等一线药物耐受或不敏感的慢性顽固性胸腰椎PHN患者。
采用视觉模拟量表（VAS）、定量感觉测试（仅用von Frey细丝）和红外热成像技术，在IVFO治疗前后识别并量化纳入的PHN患者的疼痛强度、机械性痛觉过敏区域和皮肤温度。此外，还记录了出院后停用GBP的剂量和时间以及并发症情况。
在这项为期1年的随访研究中，通过VAS测量的主要终点结果显示，IVFO治疗使出院后即刻自发疼痛显著缓解59.19%[2.67±0.66]，半年时缓解68.18%[2.08±0.89]，1年时缓解70.79%[1.91±1.19]；与入院时相比，出院后即刻机械性痛觉过敏的空间面积显著减少52.35%[3.11±0.70]，半年时减少87.41%[0.82±0.50]；出院后即刻皮肤温度降低63.01%[0.85±0.35]。此外，一半的患者在出院后3个月停止服用GBP。IVFO治疗后的1年随访期间未报告严重并发症。
这些结果表明，CT引导下的IVFO治疗是一种安全有效的介入方法，可缓解慢性、耐药性胸腰椎PHN。
