This retrospective study evaluated the comparative efficacy and safety of short-term spinal cord stimulation (st-SCS) and pulsed radiofrequency (PRF) therapy in 275 patients with thoracic herpes zoster-associated neuralgia (ZAN) treated between January 2022 and August 2024. Patients were stratified by disease duration into acute (≤ 30 days), subacute (30-90 days), and postherpetic (≥ 90 days) phases. The st-SCS group (n = 127) demonstrated superior pain relief at 3, 6, and 12 months post-treatment compared to the PRF group (n = 148), particularly in subacute and postherpetic phases (P < 0.05). While no significant intergroup difference was observed in the acute phase (P > 0.05), st-SCS showed significantly better outcomes in subsequent phases. The st-SCS group exhibited higher preoperative PQSI scores during the acute phase (P < 0.05) and improved BPI scores at 1-month follow-up (P < 0.05). Both interventions significantly reduced HADS-A and HADS-D scores at all time points (P < 0.05), with st-SCS demonstrating superior long-term improvement in depression scores (P < 0.05). These findings suggest that st-SCS provides more effective and sustained pain relief, along with greater improvements in sleep quality, emotional well-being, and quality of life compared to PRF in the management of thoracic herpes zoster-associated neuralgia.