Comparison of Two Different Neuromodulation Treatments in Patients With Acute Zoster-Related Trigeminal Neuropathic Pain and Pain Catastrophizing.

Abstract

Objective: This study aimed to compare the efficacy of two neuromodulation techniques, peripheral nerve stimulation (PNS) and pulsed radiofrequency (PRF), in patients with acute zoster-related trigeminal neuropathic pain with pain catastrophizing.

Materials and methods: A total of 65 patients with acute zoster-related trigeminal neuropathic pain and pain catastrophizing were recruited from the Department of Pain Management of the Affiliated Hospital of Southwest Medical University between March 2019 and March 2024. According to the order of enrollment, participants were randomly assigned to two groups: the PNS group (n = 31), which received stimulation of the supraorbital nerve, and the PRF group (n = 34), which underwent PRF treatment of the same nerve. Pain levels were assessed using a visual analog scale (VAS), and the dosage of the anticonvulsant pregabalin was recorded at baseline, one week, two weeks, one month, three months, and six months postoperatively. Additionally, patients were evaluated using the Pain Catastrophizing Scale (PCS) and the Short Form 36 (SF-36) Health Survey at baseline and one, three, and six months postoperatively. Both groups were also monitored for adverse events and patient satisfaction throughout the study period.

Results: Both the PNS and PRF groups experienced significant pain relief. However, the PNS group demonstrated superior outcomes compared with the PRF group at both short-term follow-up time points (p < 0.05). No significant difference in VAS scores was observed between the PNS and PRF groups during the long-term (six-month) follow-up. Improvements were noted in the SF-36 (across all eight dimensions) and PCS scores in both groups following treatment (p < 0.05). Notably, the PCS scores in the PNS group were consistently lower than those in the PRF group at all follow-up time points (p < 0.05). Additionally, patients in the PNS group exhibited greater improvements in physical role limitations, somatic pain, general health, social functioning, emotional role limitations, and mental health compared with those in the PRF group (p < 0.05). There were no significant differences between the two groups regarding improvements in physical functioning and vigor. After treatment, the average daily dose of pregabalin (mg/d) was reduced in both groups, with patients in the PNS group requiring a lower dose than those in the PRF group. Furthermore, patients in the PNS group reported a significantly higher level of satisfaction (p < 0.05) based on satisfaction evaluations. No instances of bleeding, infection, or other adverse effects were observed in either group after treatment.

Conclusion: Both PNS and PRF are effective and feasible for managing pain in patients with acute zoster-related trigeminal neuropathic pain and pain catastrophizing. However, PNS demonstrates superior efficacy in terms of early pain relief, reduction of pain catastrophizing, and improvements in quality of life, accompanied by higher patient satisfaction compared with PRF.