Comparison of Two Different Pulsed Radiofrequency Modes for Prevention of Postherpetic Neuralgia in Elderly Patients With Acute/Subacute Trigeminal Herpes Zoster

8. Herpes zoster and post herpetic neuralgia

INTRODUCTION

Patients suffering from postherpetic neuralgia (PHN) report unilateral chronic pain in one or more dermatomes after an acute herpes zoster (HZ) infection. The incidence of acute HZ ranges between three and five patients per 1000 person-years. In one out of four patients, acute HZ-related pain will transition into PHN. PHN can be very disabling for patients and reduce quality of life. Additionally, the treatment of PHN is characterized by high failure rates. The aim of this review is to give an update on the previous practical guideline published in 2011 and revised in 2015 (published in 2019) and to provide an overview of current interventional treatment options for HZ infection and PHN.

METHODS

The literature on the diagnosis and treatment of HZ and PHN was systematically reviewed and summarized.

RESULTS

The most important treatment for acute HZ-related pain is antiviral therapy within 72 h of symptom onset. Additional symptomatic treatment options are analgesic drugs according to the WHO pain ladder, tricyclic antidepressants (eg, nortriptyline), and antiepileptic drugs (eg, gabapentin). If pain is not sufficiently reduced, interventional treatment such as an epidural injection with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion (DRG) are options. Treatment for PHN is preferably transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics.

CONCLUSIONS

Treatment of acute HZ-related pain especially PHN is challenging. Besides the conventional treatment for PHN, interventional management is considered a new treatment option. PRF of DRG seems to be the most promising interventional management.

Short-Term Postoperative Depression and Anxiety in Patients with Differentiated Thyroid Carcinoma: Assessment of Potential Oncologic-Psycho Relevance

Objective: To understand whether TSH suppressive therapy affect short-term postoperative cancer-related depression and anxiety among DTC patients. To evaluate short-term postoperative psychological problems and its relationship with baseline parameters, fatigue, sleep quality, illness perception, and patients' quality of life. Study Design and Methods: This was a prospective, observational, single center study. This study involved 831 TC patients who consecutively admitted to the inpatient department of hospital between 1st June 2020 and 31th February 2021. Results: Mean scores of the self-rated anxiety scale (SAS) (49.04 vs. 40.69) and self-rated depression scale (SDS) (44.61 vs. 39.86), as well as the incidence of anxiety (41.5% vs. 22.1%) and depression (22.5% vs. 2.4%) significantly decreased 3 months after surgery. For personal and clinical characteristics, low educational background (SAS, β = 1.392; SDS, β = 1.622; and p < 0.05), without children (SAS, β = 4.068; SDS, β = 1.873, and p < 0.01), FNAC (SAS, β = -0.981; SDS, β = -2.583; and p < 0.05), and multifocal tumor (SAS, β = -1.287; SDS, β = -2.681; and p < 0.05) were the main effects for both short-term postoperative anxiety and depression. Multiple linear regression analysis identified the serum TSH level as a significant variable associated with worse SAS (Beta = -0.695 and p=0.043) and SDS (Beta = -3.133 and p < 0.001) scores 3 months after surgery. FT4 was independently associated with SAS scores (Beta = -0.202 and p < 0.001). Patients with middle ATA risk had a significantly higher level of SDS scores (p=0.033). Conclusion: We confirmed that cancer-related anxiety and depression among DTC patients significantly alleviated 3 months after surgery. TSH suppression therapy has profound effects on cancer-related anxiety and depression, and the degree of anxiety and depression significantly deteriorated with the decrease of TSH level.

Efficacy of Gasserian Ganglion High-Voltage, Long-Duration Pulsed Radiofrequency Combined With Block on Acute/Subacute Zoster-Related Trigeminal Neuralgia

Background: Trigeminal postherpetic neuralgia (TPHN) is a severe chronic pain that can lead to various socioeconomic consequences. Therefore, it is necessary to explore optimal treatment options for acute/subacute herpes zoster (HZ)-related trigeminal neuralgia and prevent the further development of TPHN. High-voltage, long-duration pulsed radiofrequency (HL-PRF) of the Gasserian ganglion is a new surgical intervention used to treat PHN. A ganglion block has been reported to possess anti-inflammatory effects and potential analgesic benefits. Methods: We included 83 patients with HZ-related acute/subacute trigeminal neuralgia admitted from January 1, 2021, to June 1, 2023, and received Gasserian ganglion HL-PRF combined with block. A 6-month follow-up was conducted, including Numerical Rating Scale (NRS) scores, Pittsburgh Sleep Quality Index (PSQI), the incidence of TPHN, the dosage of anticonvulsants and analgesics, efficacy, and adverse events. Results: All patients showed a significant decrease in postoperative NRS scores (p < 0.05). The NRS scores of the acute HZ group were consistently lower than those of the subacute HZ group at different time points (p < 0.01). The overall incidence of TPHN from the onset of HZ to 12 weeks is 21.68%. The incidence of TPHN in the acute phase group was 12.77%, significantly lower than the 33.33% in the subacute phase group (p=0.024). The effective rate was 74.7% in all patients, at 3 months after the treatment. The effective rate was 82.98% in the acute phase group and 63.89% in the subacute phase group, showing a statistically significant difference (p=0.047). The PSQI score of the acute group was consistently lower than that of the subacute group (p < 0.01). The dosage of analgesics and anticonvulsants used in the acute HZ group was lower than that in the subacute group (p < 0.01). All patients did not experience serious adverse reactions. Conclusions: Gasserian ganglion HL-PRF combined with block can be an effective and safe technique to relieve the pain of acute/subacute zoster-related trigeminal neuralgia and prevent the incidence of TPHN.

Efficacy and Safety of Pulsed Radiofrequency of Dorsal Root Ganglion in Elderly Patient Population With Acute and Subacute Zoster-Related Pain

Background: Herpes zoster (HZ) is typically characterized by a burning, stabbing pain, hyperalgesia, and allodynia. In some patients, despite the lesions resolving, the pain persists and becomes chronic. If the pain continues for more than 6 months after the onset of the pain phase, this condition is called postherpetic neuralgia (PHN). The frequency and severity of PHN increase with advancing age. The pain in PHN can be severe, sometimes resistant to medications, significantly impacting the patients' quality of life. The elderly patient population cannot tolerate the medications due to their side effects. In this situation, interventional pain treatment should be applied in the elderly patient group who have a high risk of developing PHN compared to other age groups. Method: We included patients over 65 years of age with HZ-related pain who underwent dorsal root ganglion (DRG) pulsed radiofrequency (PRF) within the first 6 months from the onset of pain. We divided these patients into 2 groups: patients who underwent intervention within the first 1 month from the onset of pain and patients who underwent intervention between 1 and 6 months. We recorded medication doses and Numeric Rating Scale (NRS) scores before the procedure and at 1 week, 1 month, 3 months, and 6 months after the procedure. Results: After the DRG PRF treatment, NRS scores improved significantly in both groups (p < 0.05). The mean NRS score in the early DRG PRF group was significantly lower than that in the late DRG PRF group (p < 0.05). The medication doses in the early DRG PRF group were significantly lower than those in the other group (p < 0.05). Conclusions: Interventional pain treatment should be applied as soon as possible in the elderly patient group who do not respond to first-line medical treatment or cannot tolerate medical treatment due to its side effects and who have a high risk of developing PHN compared to other age groups. DRG PRF, applied in the early period of medical treatment-resistant acute HZ, is safe and effective, preventing the progression to PHN.

Outcomes of Twice Repeated High-Voltage Long-Duration Pulsed Radiofrequency Treatment in Subacute Postherpetic Neuralgia: a Retrospective Single-Center Analysis

Background

The treatment of herpes zoster-related pain is challenging, and requires a variety of methods including pulse radio frequency modulation. Among them, single-time high-voltage long-term pulsed radiofrequency (HL-PRF) has been proved to be an effective treatment for subacute postherpetic neuralgia. However, it has the possibility of poor long-term curative effect and recurrence of neuralgia. In this study, we aim to identify the clinical efficacy and safety of twice repeated HL-PRF treatment in patients with subacute postherpetic neuralgia.

Design

We conducted a retrospective analysis of subacute postherpetic neuralgia patients who underwent HL-PRF treatment.

Setting

Pain Management Department of First Affiliated Hospital of Wannan Medical College.

Patients

We enrolled all patients with subacute postherpetic neuralgia, who underwent HL-PRF treatment from January 2023 to October 2023.

Measurements

The primary outcome variable was the visual Analog Scale (VAS) scores at 1, 4, 8, and 12 weeks after treatment. Secondary outcomes included Pittsburgh sleep quality index (PSQI), 36-item short-form health survey (SF-36) score, and total effective rate after treatment.

Results

A total of 63 patients were included in the analysis. Among them, 33 patients received single-time HL-PRF treatment (Group S) and 30 patients received twice repeated HL-PRF treatment (Group T). Pain scores, PSQI scores, and SF-36 score were reduced in both groups after treatment (P < 0.001). Compared to group S, the VAS scores, PSQI scores, anxiety scores, and depression scores were significantly lower at 1, 4, 8, and 12 weeks in group T. (P < 0.001). The total efficiency rate at 12 weeks after treatment of group T was statistically higher than that of group S (60.6% vs 86.7%, P < 0.05).

Conclusion

Twice repeated high-voltage long-duration PRF therapy demonstrates satisfactory efficacy in patients with subacute postherpetic neuralgia and is associated with no significant adverse reactions.

Efficacy and safety of ultrasound-guided pulsed radiofrequency in the treatment of the ophthalmic branch of postherpetic trigeminal neuralgia

Objective

To investigate the efficacy and safety of ultrasound-guided pulsed radiofrequency (PRF) targeting the supraorbital nerve for treating the ophthalmic branch of postherpetic trigeminal neuralgia.

Methods

A retrospective cohort study was conducted involving patients who presented at the Department of Pain, Affiliated Hospital of Southwest Medical University from January 2015 to January 2022. The patients were diagnosed with the first branch of postherpetic trigeminal neuralgia. In total, 63 patients were included based on the inclusion and exclusion criteria. The patients were divided into the following two groups based on the treatment method used: the nerve block (NB) group (n = 32) and the PRF + NB group (radiofrequency group, n = 31). The visual analog scale (VAS) score, Pittsburgh Sleep Quality Index (PSQI) score, and pregabalin dose were compared between the two groups before treatment, 1 week after the procedure, and 1, 3, and 6 months post-procedure, and the complications, such as local infection, local hematoma, and decreased visual acuity, were monitored post-treatment.

Results

No significant difference was found in terms of pretreatment age, sex, course of disease, preoperative VAS score, preoperative PSQI score, and preoperative pregabalin dose between the two groups (P > 0.05). The postoperative VAS score, PSQI score, and pregabalin dose were significantly decreased in both groups. Furthermore, significant differences were found between the two groups at each preoperative and postoperative time point (P < 0.05). The VAS score was lower in the radiofrequency group than in the NB group at 1, 3, and 6 months, and the difference was statistically significant (P < 0.05). The PSQI score was lower in the radiofrequency group than in the NB group at 1 week, 1, 3, and 6 months post-procedure, and the difference was statistically significant (P < 0.05). The dose of pregabalin was lower in the radiofrequency group than in the NB group at 1 week, 1, 3, and 6 months post-procedure, and the difference was statistically significant at 3 and 6 months (P < 0.05). After 6 months of treatment, the excellent rate of VAS score in the radiofrequency group was 70.96%, and the overall effective rate was 90.32%, which was higher than that in the NB group. The difference in the efficacy was statistically significant (P < 0.05).

Conclusion

PRF targeting the supraorbital nerve can effectively control the pain in the first branch of the trigeminal nerve after herpes, enhance sleep quality, and reduce the dose of pregabalin. Thus, this study shows that PRF is safe under ultrasound guidance and is worthy of clinical application.

Comparing the efficacy and safety of high-voltage and standard-voltage pulsed radiofrequency for the treatment of postherpetic neuralgia: A pooled analysis from randomized controlled trials

Postherpetic neuralgia (PHN) is one of the most common and serious complications of herpes zoster infection. Pulsed radiofrequency (PRF) therapy has emerged to be a neuromodulation technique for the treatment of PHN. Two therapeutic options are available for PRF, including high-voltage and standard-voltage PRF. Some studies suggested that the former one had better clinical efficacy than the latter one. For the first time, this pooled analysis compared the efficacy and safety of these two surgeries for the treatment of PHN. Five commonly used databases were applied to identify the eligible studies. This study was registered on the PROSPERO (ID: CRD42023460236), which provided more relevant information. Finally, four randomized controlled trials (RCTs) with 285 participants were included. The combined odds ratios (OR) showed that high-voltage PRF exhibited a significantly higher treatment efficiency than the standard PRF (OR = 1.4, 95%CI: 1.16 to 1.69, P < 0.001). Additionally, the visual analogue scale (VAS) in the high-voltage PRF group was significantly lower than that of the standard PRF group at one week (SMD = -0.776, 95%CI: -1.408 to -0.145, P = 0.016), one month (SMD = -0.544, 95%CI: -0.907 to -0.180, P = 0.003), and three months (SMD = -1.096, 95%CI: -1.504 to -0.687, P < 0.001) after treatment, particularly at the three months after surgery. However, the VAS was comparable between the two groups (SMD = -0.94, 95%CI: -1.985 to 0.104, P = 0.077). Patients who underwent high-voltage PRF did not have a significantly higher incidence of adverse events than those with standard PRF (OR = 1.56, 95%CI: 0.78 to 3.13, P = 0.208). In summary, the current study revealed that high-voltage PRF is superior to standard-voltage PRF in improving analgesic efficacy in patients with PHN. Additionally, it does not increase the incidence of treatment-related adverse effects. Further studies are still warranted to determine the optimal voltage and duration of PRF treatment for patients with PHN.

Radiofrequency regulation of the sphenopalatine ganglion in managing herpes zoster ophthalmicus neuralgia: A case series

INTRODUCTION

Trigeminal herpes zoster, which comprises 10% to 20% of cases of herpes zoster, often leads to severe pain in the ophthalmic branches. Current treatments, including drug therapy and minimally invasive interventions, have limitations; accordingly, there is a need to explore alternative approaches. This study aimed to evaluate the efficacy and safety of computerized tomography (CT)-guided pulsed radiofrequency of the sphenopalatine ganglion in patients with intractable trigeminal herpetic pain.

PATIENT CONCERNS

Three patients with intractable trigeminal ophthalmic zoster neuralgia were studied. All patients complained of bursts of headache, which occurred at least 10 times a day, usually in the periorbital and frontal regions. Conventional treatments, including oral medications and radiofrequency therapy targeting the trigeminal-semilunar ganglion and supraorbital nerve, could not sufficiently provide relief.

DIAGNOSIS

Two patients were diagnosed with herpes zoster in the ocular branch of the trigeminal nerve with conjunctivitis, while one patient was diagnosed with postherpetic neuralgia in the ocular branch of the trigeminal nerve.

INTERVENTIONS

This study employed a novel approach that involved CT-guided radiofrequency regulation of the pterygopalatine fossa sphenopalatine ganglion.

OUTCOMES

In all three patients, pain relief was achieved within 1 to 3 days after treatment. During the follow-up, one patient had pain recurrence; however, its severity was ≈ 40% lower than the pretreatment pain severity. The second patient had sustained and effective pain relief. However, the pain of the third patient worsened again after 2 months. The average follow-up duration was 3 months. None of the enrolled patients showed treatment-related adverse reactions or complications.

CONCLUSION

Our findings indicated that CT-guided radiofrequency regulation of the pterygopalatine fossa sphenopalatine ganglion was a safe and effective intervention for pain in patients with trigeminal ophthalmic zoster neuralgia, suggesting that it may be a therapeutic option if other treatments fail.

Trigeminal Postherpetic Neuralgia: From Pathophysiology to Treatment

PURPOSE OF REVIEW

Trigeminal postherpetic neuralgia (TG-PHN) is a neuropathic pain condition complicating herpes zoster (HZ) attributed to the trigeminal nerve. It poses significant challenges due to its persistent and debilitating nature. This review explores the clinical characteristics of TG-PHN, analyzes its pathophysiological underpinnings, and addresses existent and potential therapies.

RECENT FINDINGS

TG-PHN is one of the most common and complex PHN locations. It has distinguishing clinical and pathophysiological characteristics, starting with viral triggered injuries to the trigeminal ganglion (TG) and peripheral tissue and involving the ascending and descending brain modulation pathways. Current therapies include vaccines, oral and topical medications, and interventional approaches, like nerve blocks and neurostimulation. This review covers TG-PHN's clinical and physiological components, treatment options, and potential future targets for improved management. By exploring the complexities of this condition, we aim to contribute to developing more effective and targeted therapies for patients suffering from trigeminal PHN.

Efficacy of High-Voltage Pulsed Radiofrequency in Zoster-Associated Pain: A Meta-Analysis and Systematic Review

Background

Zoster-associated pain (ZAP) is often refractory to conventional treatments and can seriously affect patients' physical and mental health. High-voltage pulsed radio frequency (H-PRF) is a new method for treating ZAP with pulse voltages above 60 V or even up to 100 V. The purpose of this paper was to conduct a systematic review and meta-analysis to evaluate the efficacy of H-PRF in the management of ZAP.

Methods

PubMed, Embase, and the Cochrane library were searched from their inception to June 2022 to identify controlled trials which evaluated the effectiveness of H-PRF compared with standard PRF and sham operations. The primary outcome was pain scores at different treatment times. The secondary outcomes included SF-36 scores, rescue analgesic dose, and side effects.

Results

We reviewed 6 randomized controlled trials involving 428 patients. There was no significant difference between the H-PRF and standard PRF pain scores at 1 week after surgery and the sham operation group at 1 month. At 1, 3, and 6 months, the H-PRF group had better pain score than the standard PRF group, and at 3 months, the pain score was better than the sham operation group. The H-PRF group showed improvement in the SF-36 score, and there were no significant complications in the H-PRF group.

Conclusions

H-PRF is an effective and safe treatment method that has better effects in relieving pain and improving the quality of life and physical and mental health. Although H-PRF provides pain relief rates comparable to those of the control group in the early stages, it remains the preferred and alternative treatment for relieving herpes zoster-related pain.

Dual-neuromodulation strategy in pain management of herpes zoster ophthalmicus: retrospective cohort study and literature review

BACKGROUND

Effective pain control of herpes zoster ophthalmicus (HZO) is not only essential to attenuate the clinical symptoms but to reduce the risk of postherpetic neuralgia development. Recently, neuromodulation therapy has been one promising option for neuropathic pain and increasingly applied in management of zoster-related pain. One key factor of neuromodulation treatment is the therapeutic site for the impaired nerves. In this study we aim to investigate one novel dual-neuromodulation strategy, targeting the level of the peripheral branch and trigeminal ganglion, in the pain management of HZO.

METHODS

Dual neuromodulation strategy combining short-term peripheral nerve stimulation (PNS) with pulsed radiofrequency (PRF) of trigeminal ganglion was compared with single PNS treatment for HZO-related pain. Clinical recordings of patients were retrospectively reviewed. The primary outcome was the pain severity, assessed by the visual analogue scale (VAS) before and after neuromodulation therapy.

RESULTS

PNS achieved significant relief of pain with or without PRF treatment before discharge, which provided enduring therapeutic effect up to 12-month follow-up. The mean reduction of VAS was 6.7 ± 1.4 in dual modulation therapy (n = 13) at last follow-up and 5.4 ± 1.5 in PNS subgroup (n = 20), respectively. Moreover, dual modulation strategy provided better control of pain compared with PNS therapy alone at each time point.

CONCLUSION

It is feasible and effective to combine the PNS and PRF in pain management of HZO. This novel dual modulation strategy of trigeminal pathway may provide additional therapeutic effects of pain symptoms in HZO population.

Efficacy and Safety of Pulsed Radiofrequency in Herpes Zoster Related Trigeminal Neuralgia: A Systematic Review and Meta-Analysis

Purpose

Pulsed radiofrequency (PRF) is a neuromodulation technique for neuropathic pain. However, the effects of PRF on zoster-related trigeminal neuralgia (TN) remain unclear. The purpose of this meta-analysis is to investigate the efficacy and safety of PRF in the management of zoster-related TN.

Patients and Methods

We searched PubMed, Embase, Cochrane Library, Chinese Biomedical Database (CBM), Chinese National Knowledge Infrastructure (CNKI), and Wanfang for randomized controlled trials from their inception to August 2022. The primary clinical outcomes included pain intensity and adverse events. Secondary clinical outcomes included pain remission rate, trigeminal postherpetic neuralgia (TPHN) incidence, rescue analgesic dose, sleep quality, and quality of life (QoL).

Results

Eight studies with 788 participants were included for final analysis. PRF group exhibited lower pain scores (week 1: MD -2.10, 95% CI -3.28 to -0.93, P=0.0005; week 4: MD -1.56, 95% CI -2.60 to -0.51, P=0.003; week 12: MD -1.52, 95% CI -2.68 to -0.35, P=0.01), lower risk of TPHN incidence (RR 0.22, 95% CI 0.06 to 0.81, P=0.02) and better sleep quality (week 4: MD -2.52, 95% CI -3.28 to -1.77, P<0.01; week 12: MD -2.25, 95% CI -2.90 to -1.60, P<0.01) than control group. Besides, pain remission rate (RR 1.08, 95% CI 0.93 to 1.26, P=0.31) and adverse events (RR 0.95, 95% CI 0.71 to 1.27, P=0.74) were comparable in both groups.

Conclusion

PRF is an effective and safe treatment and it yields better effects in pain relief, improvement of sleep quality, and prevention of developing TPHN. Although PRF provides a comparable pain remission rate with the control, it is still a preferred and alternative treatment for relieving zoster-related facial pain.

Efficacy and safety of high-voltage versus standard-voltage pulsed radiofrequency ablation for patients with neuropathic pain: protocol for a systematic review and meta-analysis

INTRODUCTION

Pulsed radiofrequency (PRF) ablation is commonly used for the treatment of neuropathic pain (NP). However, it is unclear whether increasing the output voltage of PRF can safely improve its efficacy. This study aims to compare the efficacy and safety of high-voltage PRF ablation and standard-voltage PRF ablation for the treatment of patients with NP.

METHODS AND ANALYSIS

We will search PubMed/MEDLINE, EMBASE, Web of Science, the Cochrane Library, conference proceedings for relevant abstracts, clinical trials registers (ClinicalTrials.gov) and the WHO's International Clinical Trial Registry Platform (from the date of inception until 15 March 2022). Only randomised controlled trials will be included. Two reviewers (YJ and GF) will independently perform study screening and selection, data extraction, risk-of-bias assessment and quality-of-evidence assessment. The primary outcome of this meta-analysis will be the efficiency rate in patients with NP. The secondary outcomes will include numeric rating scale score, visual analogue scale score, time to take effect, rescue drug dosage, quality of life using the health questionnaire (SF-36) and the incidence of adverse events. Meta-analyses will be conducted using standard meta-analysis software (RevMan V.5.3, The Nordic Cochrane Center, The Cochrane Collaboration, Copenhagen, Denmark).

ETHICS AND DISSEMINATION

The requirement for ethical approval was waived as our systematic review will be based on the published literature. The results of this study will be submitted to a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42022297804.

Short-Term Spinal Cord Stimulation or Pulsed Radiofrequency for Elderly Patients with Postherpetic Neuralgia: A Prospective Randomized Controlled Trial

Background. Postherpetic neuralgia (PHN) is the most common and severe complication after varicella-zoster infection, especially in elderly patients. PHN is always refractory to treatment. Both pulsed radiofrequency (PRF) and short-term spinal cord stimulation (stSCS) have been used as effective analgesia methods in clinic. However, which technique could provide better pain relief remains unknown. Objectives. This study is aimed at evaluating the efficacy and safety of PRF and stSCS in elderly patients with PHN. Study Design. A prospective, randomized-controlled study. Setting. Department of Pain Management, the Second Affiliated Hospital of Guangzhou Medical University. Methods. A total of 70 elderly patients with PHN were equally randomized to the PRF group or stSCS group. Patients in the PRF group received PRF treatment, while patients in the stSCS group received stSCS treatment. The primary outcome was the effective rate. The secondary outcomes included the Visual Analogue Scale (VAS), the 36-Item Short Form Health Survey Questionnaire (SF-36), and the pregabalin dosage. All outcomes were evaluated at baseline and at different postoperative time points. Results. At 12 months after surgery, the effective rate reached 79.3% in stSCS group, while 42.1% in PRF group. The effective rate was significantly higher in the stSCS group than in the PRF group at 3, 6, and 12 months after surgery. VAS scores decreased significantly at each postoperative time point in both groups ( $P<0.001$ ). The VAS scores were significantly lower in the stSCS group than in the PRF group at 3, 6, and 12 months after surgery. SF-36 scores (bodily pain and the physical role) were significantly improved at each postoperative time point in both groups ( $P<0.001$ ). The SF-36 scores were significantly higher in the stSCS group than in the PRF group at some postoperative time points. The pregabalin dosage was significantly lower in the stSCS group than in the PRF group at 3, 6, and 12 months after surgery. Limitations. A single-center study with a relatively small sample size. Conclusions. Both PRF and stSCS are effective and safe neuromodulation techniques for elderly patients with PHN. However, stSCS could provide better and longer-lasting analgesic effect compared to PRF.

MiR-199-3p Suppressed Inflammatory Response by Targeting MECP2 to Alleviate TRX-Induced PHN in Mice

Varicella zoster virus–induced postherpetic neuralgia (PHN) can be alleviated by limited medications with serious side effects. This study aims to investigate the underlying molecular mechanism of miR-199-3p in mediating PHN in mice. 293T cells were transfected with miR-199-3p vectors (mimic/inhibitor). The target relationship between miR-199-3p and MECP2 was confirmed using luciferase reporter assay. PHN mouse model was established by TRX injection. Animal behaviors were evaluated using Hargreaves test and Von Frey test. Western blot was used for protein analysis, and quantitative reverse transcription polymerase chain reaction was performed for messenger RNA quantification. Serum levels of inflammatory mediators were determined using ELISA. Paw withdrawal latency (PWL) and mechanical withdrawal threshold (MWT) were decreased in resiniferatoxin-induced PHN mice. Downregulated miR-199-3p and upregulated MECP2 were found in PHN mice. Upregulated miR-199-3p increased PWL and MWT, but inhibited MECP2 in PHN mice. Besides, increased miR-199-3p suppressed proinflammatory indicators and activated anti-inflammatory mediators. It also found that MECP2 was the target of miR-199-3p. Further study showed miR-199-3p enhanced PWL and MWT, and supported inflammatory response via targeting MECP2. miR-199-3p regulated inflammation by targeting MECP2 to alleviate TRX-induced PHN in mice.