The Effect of CT-Guided Pulsed Radiofrequency Combined with Ozone Injection on Zoster-Associated Pain: A Retrospective Study

Abstract

Purpose

Globally, the incidence of herpes zoster (HZ) is increasing, and the resulting zoster-associated pain (ZAP) severely affects the quality of life of patients. Therefore, active treatment of ZAP and prevention of postherpetic neuralgia (PHN) are very important for patients in the early stage of the disease. This retrospective observational study aimed to evaluate the effect of CT-guided pulsed radiofrequency (PRF) combined with ozone injection on zoster-associated pain.

Patients and Methods

From 2018 to 2020, 84 patients with AHN (n=28), SHN (n=32), or PHN (n=24) underwent PRF combined with ozone injection treatment after pharmacologic and conservative therapies failed. The visual analogue scale (VAS), the Pittsburgh Sleep Quality Index (PSQI), and pregabalin consumption were recorded at baseline, post-PRF, and at 1, 3, 6, and 12 months after treatment. The number of remediations performed and adverse reactions were recorded, and treatment inefficiency was calculated using a VAS score greater than 3 as the criterion.

Results

The pooled results demonstrated statistically significant decreases in VAS scores, PSQI scores and consumption of pregabalin post-PRF and at 1, 3, 6, and 12 months follow-up (P<0.05). Compared with the PHN group, both the AHN and SHN groups showed clinical and statistical improvement in VAS scores and PSQI scores and in consumption of pregabalin (P< 0.05). At 1 year after the operation, the PHN group had a significantly greater number of remediation events and greater treatment inefficiency than the other two groups. No serious adverse events were observed during the procedure or during the follow-up period.

Conclusion

CT-guided PRF combined with ozone injection is safe and effective for individuals with ZAP, and its short-term and long-term effects are significant. In a sense, early PRF combined with ozone injection is more effective.

Keywords:

• herpes zoster
• zoster-associated pain
• postherpetic neuralgia
• radiofrequency
• ozone

Abbreviations

AHN, acute herpetic neuralgia; BP, blood pressure; DRG, dorsal root ganglia; HR, heart rate; HZ, Herpes zoster; IVF, intervertebral foramen; PHN, postherpetic neuralgia; PRF, pulsed radiofrequency; PSQI, Pittsburgh Sleep Quality Index; SHN, subacute herpetic neuralgia; T0, at baseline; T1, post-PRF; T2, at 1 month after PRF; T3, at 3 months after PRF; T4, at 6 months after PRF; T5, at 12 months after PRF; VAS, visual analogue scale; VZV, varicella zoster virus; ZAP, zoster-associated pain.

Disclosure

The authors report no conflicts of interest in this work.