Steroid, Ozone Injection With PRF Therapy Safe, Effective for Herpes Zoster Neuralgia

Computer illustration of a varicella zoster virus particle, the cause of chickenpox and shingles. Varicella zoster virus is also known as human herpes virus type 3 (HHV-3).
Researchers tested the safety and efficacy of treating herpes zoster neuralgia with steroid and ozone injection and CT-guided pulsed radiofrequency.

Steroid and ozone injection combined with PRF therapy was found to be safe and effective for the treatment of herpes zoster neuralgia, according to study results published in the Journal of Pain Research.

Patients with herpes zoster neuralgia (N=104) were enrolled at the Affiliated Hospital of Jiaxing University in China from 2020 to 2021. All patients had involvement of the unilateral cervical 3-8 nerves (ranging from cervical 2-4 to cervical 8-thoracic 2). Study participants received PRF modulation therapy of the spinal dorsal root ganglion and a steroid (100 mg 2% lidocaine hydrochloride, 1 mg betamethasone, 1 mg mecobalamin, 2 mL contrast diluted in 15 mL 0.9% saline) and ozone (40 μg/mL) injection (3 mL per affected segment) using a posterior and upper quarter of the cervical foramina puncture approach with computed tomography (CT) guidance. Safety and efficacy were assessed up to 12 weeks.

The patient population comprised 65 men and 39 women with a median age of 72 (range, 25-93) years.

A total of 254 procedures were successfully administered with a puncture failure rate of 1.17%. Each patient received a mean of 2.77 procedures with 1.67 injections per procedure. The injection success rate was 99.21%.

The average pain 10-point numerical rating score (NRS) was 5.75±0.682 at baseline, 2.6±1.023 postprocedure, 2.21±0.925 at week 2, 1.89±1.162 at week 4, and 1.43±1.369 at week 12 (all P =.000 compared with baseline).

Use of pain medications was significantly reduced from baseline compared with 1 and 3 months (both P <.0001).

Adverse events included sleep disorder, facial flushing, itch, intermittent fatigue, and need for steroid intravascular injection.

The study was limited by its lack of randomization and blinding.

The data indicated that a CT-guided injection of steroid and ozone combined with PRF therapy significantly reduced pain and medication use among patients with herpes zoster neuralgia. Additional trials are needed to confirm the safety and efficacy of this approach.

“Our study provides safety techniques for CT-guided puncture technology and can serve as an effective reference for PRF combined with steroid and ozone injection in the clinical treatment of patients with herpes zoster involving the C3-C8 area,” the study authors noted.


Ma L, Yao M. Safety and efficacy of CT-guided pulsed radiofrequency combined with steroid and ozone injection-treated cervical 3-8 herpes zoster neuralgia using a posterior and upper quarter of the cervical foramina puncture approach. J Pain Res. Published online January 6, 2022. doi:10.2147/JPR.S333481