Zoster-Related Trigeminal Neuralgia Outcomes Improved With Pulsed Radiofrequency Treatment

Pulsed radiofrequency treatment for zoster-related trigeminal neuralgia was found to be associated with pain relief and improved sleep quality, and prevented trigeminal postherpetic neuralgia more effectively than other treatments, according to the results of a study published in the Journal of Pain Research.

Study authors, from Capital Medical University in China, report that “[t]his chronic and severe facial pain caused by [herpes zoster] infection has led to a great social burden and a poor patients’ quality of life.” To that end, they conducted a systematic review and meta-analysis by which they searched publication databases through August 2022 for randomized controlled trials of therapies for poorly controlled zoster-related trigeminal neuralgia. A total of 8 studies were included in this analysis.

The studies were published between 2013 and 2022 and compared the effects of gasserian ganglion pulsed radiofrequency (n=2), supraorbital nerve pulsed radiofrequency (n=2), supraorbital/maxillary/mandibular pulsed radiofrequency plus gabapentin (n=2), gasserian ganglion pulsed radiofrequency plus stellate ganglion block (n=1), or gasserian ganglion pulsed radiofrequency plus pregabalin (n=1) with supraorbital nerve block (n=2), supraorbital/maxillary/mandibular nerve block plus gabapentin (n=2), stellate ganglion block (n=1), pregabalin (n=1), gabapentin and tramadol (n=1), or sham treatment (n=1).

The pooled study population consisted of 788 patients. The mean age of the study population ranged from 48.3 to 67.2 years, and duration of trigeminal neuralgia ranged between an average of 5.8 days and 5.5 months.

In the pooled analysis, pulsed radiofrequency was superior to the comparator treatments for relieving zoster-related facial pain (mean difference [MD], -1.17; 95% CI, -1.91 to -0.42; I², 99%; P =.002). Results were consistent in the leave-1-out analysis.

Stratified by follow-up time, pulsed radiofrequency was not superior to the comparator treatments for relieving pain intensity at days 1 to 3 (MD, -1.91; 95% CI, -4.10 to 0.28; I², 99%; P =.09) but was more effective at weeks 1 (MD, -2.10; 95% CI, -3.28 to -0.93; I², 97%; P =.005), 4 (MD, -1.56; 95% CI, -2.60 to -0.51; I², 98%; P =.003), and 12 (MD, -1.52; 95% CI, -2.68 to -0.35; I², 98%; P =.01).

Stratified by disease course, pulsed radiofrequency was favored over comparator treatments among patients with trigeminal neuralgia lasting less than 3 months and those with trigeminal neuralgia lasting more than 3 months at the 4- and 12-week follow-up assessments (MD range, -1.97 to -0.90; all P ≤.05).

Among treatment targets, gasserian ganglion was superior to comparator treatments (MD, -1.68; 95% CI, -3.01 to -0.35; I², 99%; P =.01) but trigeminal nerve was not (MD, -0.63; 95% CI, -1.42 to 0.16; I², 96%; P =.12).

For secondary outcomes, pulsed radiofrequency was favored over comparator treatments for improving sleep quality at weeks 4 (MD, -2.52; 95% CI, -3.28 to -1.77; I², 0%; P <.01) and 12 (MD, -2.25; 95% CI, -2.90 to -1.60; I², 0%; P <.01), decreasing the incidence of trigeminal postherpetic neuralgia (RR, 0.22; 95% CI, 0.06-0.81; I², 0%; P =.02), and improving all outcomes in the 36-item Short-Form Health Survey (all P <.01).

Risk for adverse events did not differ significantly between pulsed radiofrequency and comparator treatment arms (relative risk [RR], 0.95; 95% CI, 0.71-1.27; I², 0%; P =.74).

A major limitation of this analysis was the high heterogeneity observed in most comparisons.

These data indicate that pulsed radiofrequency, especially when targeted at the gasserian ganglion, was associated with better pain relief and sleep quality, and was more effective at preventing trigeminal postherpetic neuralgia, compared with other treatments among patients with zoster-related trigeminal neuralgia.