Computed tomography-guided pulsed radiofrequency (PRF) therapy may offer pain relief, improve quality of life, and reduce medication use in patients with trigeminal postherpetic neuralgia (TPHN), according to study results published in Frontiers in Neuroscience.

TPHN-associated pain is often unresponsive to conventional medications, and peripheral nerve blocks offer only short-term relief. PRF does not result in nerve damage and has been shown to provide long-lasting relief.

A total of 90 patients >50 years old with TPHN and pain scores ≥5 on a 0 to 10 visual analog scale (VAS) were enrolled between 2014 and 2016 in a comparative study. Participants were randomly assigned to receive peripheral nerve (supraorbital/infraorbital/mental nerves) PRF (n=45; mean age, 64.89 years; 55.6% women) or gasserian ganglion PRF (n=45; mean age, 64.76 years; 51.1% women) at 42°C for 300 seconds. All participants were given steroid injections after the procedure and were prescribed opioid analgesics and anticonvulsant medication. Follow-up occurred at 1 week, and at 1, 3, 6, and 12 months after surgery and consisted of VAS pain assessments, 36-item Short Form Health Survey (SF-36) results, total efficiency rate estimations, and review of opioid and anticonvulsant medication dosages.

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All procedures were successfully completed without any serious adverse events. In both treatment groups, VAS scores were reduced, SF-36 scores were increased on the mental and physical components, and drug dosages were reduced at all postsurgical time points compared with presurgical levels (P <.05). Participants who received PRF at the gasserian ganglion had better outcomes for all measures compared with those in whom the peripheral nerves were targeted (P <.05). The lowest and highest scores on the VAS and SF-36 were observed at 3 months in both groups.

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One year after the procedure, total efficiency rates were estimated as 68.9% and 86.7% in the peripheral nerve and gasserian ganglion groups, respectively, indicating superiority of PRF targeting the gasserian ganglion technique (P <.05). Satisfaction was also higher in patients receiving treatment at the gasserian ganglion vs peripheral nerves.

“In summary, PRF is a recommend[ed] treatment to relieve the pain of TPHN. PRF treatment of gasserian ganglion was more effective than treatment of the associated peripheral nerves,” noted the authors.

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Ding Y, Hong T, Li H, Yao P, Zhao G. Efficacy of CT guided pulsed radiofrequency treatment for trigeminal postherpetic neuralgia. Front Neurosci. 2019;13:708.