Ultrasound-guided pulsed radiofrequency applied to intercostal nerves may be safe and effective for managing thoracic postherpetic neuralgia-associated pain, according to a study published in the Clinical Journal of Pain.

For this randomized, double-blind, placebo-controlled trial, 43 patients with postherpetic neuralgia for >6 months who attended an institutional pain clinic were enrolled. Investigators randomly assigned patients to receive ultrasound-guided pulsed radiofrequency (n=21) or a sham control (n=22) after 2 weeks of treatment with 150 mg pregabalin for 12 hours. Patients receiving radiofrequency underwent 2 cycles of the treatment at 42°C for 120 seconds over the intercostal nerves of the affected thoracic dermatome had been localized using ultrasound. Participants in the control group received a sham intervention that was of a similar duration.

Investigators assessed total analgesic consumption and pain scores using the Visual Analogue Scale at baseline, every 2 weeks for 6 months, and after 9 and 12 months. Quality-of-life outcomes were also evaluated with questionnaires at baseline and at 1, 3, 6, and 12 months after intervention.

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Participants receiving radiofrequency treatment reported reduced pain scores from the second week after the start of treatment until the end of the study period (P <.001 for all).

Participants receiving radiofrequency treatment also consumed lower amounts of pregabalin and acetaminophen medications compared with patients in the control group, an effect that was sustained for 9 months (P <.001 for all). The general health perception, social function, mental health index, bodily pain index, vitality, and physical function domains of the Short-Form-36 questionnaire were also improved by the radiofrequency vs sham treatment at 1, 3, 6, and 12 months (P <.05 for all).

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Limitations of the analysis include the small sample size and a reliance on self-evaluation of outcomes.

“[Pulsed radiofrequency] is a reproducible, non-destructive technique which has gained popularity among pain physician to induce long-term pain relief,” noted the study’s authors. “The mechanism by which [pulsed radiofrequency] causes pain relief is debatable. A popular theory is that the rapidly changing electric fields produced by [pulsed radiofrequency] alter the transmission of pain signals via a pathway involving c-Fos, a so-called immediate early gene,” they added.

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Makharita MY, El Bendary HM, Sonbul ZM, Ahmed SES, Latif MA. Ultrasound-guided pulsed radiofrequency in the management of thoracic post-herpetic neuralgia: a randomized, double-blinded, controlled trial [published online May 11, 2018]. Clin J Pain. doi: 10.1097/AJP.0000000000000629