From Short-Term Relief to Long-Term Management: A Meta-Analysis of Temporary Spinal Cord Stimulation and Pulsed Radiofrequency in Postherpetic Neuralgia.

Abstract

Objective: This study aimed to conduct a meta-analysis comparing the efficacy of temporary (ie, without implantable pulse generator) spinal cord stimulation (SCS) and pulsed radiofrequency (PRF) in managing postherpetic neuralgia (PHN).

Materials and methods: A systematic review was performed using Scopus, PubMed, Cochrane CENTRAL, Web of Science, and Embase databases through January 1, 2025, targeting randomized controlled trials (RCTs) comparing SCS and PRF in PHN management. Two independent reviewers undertook screening, extracted data, and assessed risk of bias using the Cochrane Risk-of-Bias 2.0 tool. The meta-analysis used Review Manager 5.4 to assess pain intensity, treatment success, medication reduction, and quality of life. Subgroup analyses were performed based on the follow-up duration.

Results: Four RCTs involving 125 patients with SCS and 136 with PRF were analyzed. SCS significantly reduced pain intensity after one month (mean difference [MD]: -0.98, 95% CI: -1.77, -0.19), three months (MD: -1.34, 95% CI: -2.59, -0.09), and six months (MD: -1.27, 95% CI: -2.30, -0.23). Treatment success (>50% pain reduction) favored SCS at three months (risk difference: 0.37, 95% CI: 0.10, 0.63) and beyond. SCS significantly reduced pregabalin use at three (MD: -27.88 mg, 95% CI: -39.12, -16.64) and 12 months. Quality-of-life improvements in SCS were significant for 36-Item Short Form Health Survey bodily pain and physical role domains from six months onward.

Conclusion: SCS outperformed PRF in mid- and long-term outcomes for PHN, including pain reduction, treatment success, and quality-of-life improvements. PRF remains a viable short-term alternative to SCS. Further research should focus on the cost-effectiveness, safety, and long-term efficacy of this approach.