Repeated High-Voltage Pulsed Radiofrequency Reduces Postherpetic Neuralgia Incidence in Diabetic Patients with Thoracic Herpes Zoster
核心洞察
A retrospective study of 109 patients found that repeated high-voltage pulsed radiofrequency (RHV-PRF) reduced clinically meaningful postherpetic neuralgia (搜索) incidence to 20.8% versus 41.1% with a single session at 12 weeks.
NRS pain scores and PSQI sleep quality scores were significantly lower in the RHV-PRF group at all follow-up timepoints (1, 4, 8, and 12 weeks post-procedure).
HbA1c levels at 12 weeks were lower in the repeated-treatment group, suggesting a potential analgesic-metabolic benefit that may interrupt the neuralgia-hyperglycemia vicious cycle.
A retrospective analysis from Hangzhou Third People's Hospital (搜索) suggests that administering two sessions of high-voltage pulsed radiofrequency (HV-PRF) on consecutive days significantly outperforms a single session in preventing clinically meaningful postherpetic neuralgia (搜索) (PHN) and improving pain and sleep outcomes in diabetic patients with thoracic herpes zoster (搜索) neuralgia (HZN). The findings, published in the Journal of Pain Research, address a challenging clinical population where diabetes mellitus (搜索) (DM) and HZN frequently co-occur, creating a bidirectional "neuralgia–hyperglycemia" cycle that complicates management.
Study Design and Patient Population
The study analyzed 109 patients drawn from hospital records spanning March 2022 to October 2025. All participants had thoracic HZN with symptom duration under one month, an established diagnosis of type 2 diabetes mellitus (搜索), and a Numeric Rating Scale (NRS) score exceeding 5. Patients were divided into two groups based on their chosen treatment modality: 56 received a single HV-PRF session (Group SHV-PRF) and 53 received two sessions performed on consecutive days (Group RHV-PRF). Baseline characteristics—including age, gender, disease duration, HbA1c levels, fasting blood glucose, pregabalin dose, and PRF voltage—showed no significant differences between groups.
The procedure employed CT-guided targeting of the thoracic dorsal root ganglion (DRG) with a 22-gauge, 10 cm electrode. High voltage was defined as an initial output of 50 V, titrated upward in 5–10 V increments to each patient's tolerable limit. The manual PRF mode used a pulse width of 20 ms, frequency of 2 Hz, duration of 600 seconds, and a temperature limit of 42°C.
Primary and Secondary Outcomes
The primary endpoint—incidence of clinically meaningful PHN at 12 weeks post-PRF—was significantly lower in the repeated-treatment group (20.8% vs. 41.1%; OR=2.661, 95% CI: 1.136–6.232, P < 0.05).
NRS pain scores were consistently lower in the RHV-PRF group across all follow-up timepoints, with mean differences at 1, 4, 8, and 12 weeks of 1.710, 1.601, 1.700, and 1.566, respectively (P < 0.05 for all comparisons). Similarly, Pittsburgh Sleep Quality Index (PSQI) scores favored repeated treatment, with mean differences of 3.080, 2.413, 2.152, and 2.278 at the same intervals (P < 0.05).
Notably, HbA1c levels at 12 weeks post-PRF were lower in the RHV-PRF group (mean difference: 1.548, 95% CI: 1.102–1.994, P < 0.05). The authors caution that confounding factors such as baseline glycemic severity and medication changes were not rigorously controlled, but speculate that superior analgesia may interrupt the stress-induced sympathoadrenal and hypothalamic-pituitary-adrenal axis activation that drives insulin resistance and glucose volatility.
No serious adverse events—including nerve damage, hemopneumothorax, hematoma, or local infection—were reported in either group, and no rescue analgesic measures were required.
Clinical Context and Implications
Diabetes mellitus (搜索) impairs glucose metabolism through polyol pathway activation, compromised cellular immunity, and microangiopathy, all of which increase susceptibility to varicella-zoster virus reactivation. Patients with DM carry an 84–164% elevated risk of HZ development and a 23–31% higher likelihood of progression to PHN. The resulting neuralgia triggers counter-regulatory hormone surges that exacerbate hyperglycemia, which in turn upregulates pro-inflammatory cytokines (NF-κB, TNF-α, IL-6) and oxidative stress, worsening neuronal injury.
The authors propose that repeated PRF stimulation acts on injured nerves multiple times, promoting neurorepair, resolving neuroinflammation, normalizing aberrant discharges, and enhancing neuroplasticity while reducing central sensitization. Two sessions within one week deliver cumulative, prolonged DRG stimulation that consolidates therapeutic effects.
Limitations
The study was non-randomized and retrospective, conducted at a single center with a relatively small sample. The optimal interval and number of repeated treatments remain undetermined, and no separate standard PRF or pharmacological-only control group was included. The authors emphasize that results should be interpreted as exploratory associations and call for a prospective randomized controlled trial to confirm the therapeutic advantage of repeated HV-PRF in this population.