Efficacy, Safety, and Predictors of Response to Pulsed Radiofrequency Therapy for Acute Zoster-Related Trigeminal Neuralgia Patients: A Multicenter Retrospective Study

Background: The scarcity of an effective and safe therapy to relieve acute zoster-related trigeminal neuralgia (TN) and preventing it from developing into trigeminal postherpetic neuralgia is well known. Pulsed radiofrequency (PRF) is a novel and safe, minimally neuro-destructive technique for the treatment of acute zoster-related TN, which attains satisfactory pain relief. However, this result is only reported by a few single-center researches. In addition, no study has reported the predictive factors of the analgesic effect for PRF treatment on acute zoster-related TN patients. Objectives: This study aimed to investigate the analgesic effect of computed tomography (CT)-guided PRF for acute zoster-related TN, and to explore determinants of the therapeutic efficacy of PRF based on clinical evidence at multiple centers. Study Design: Retrospective, multicenter, observational clinical study. Settings: The study was conducted at pain management centers in Beijing Tiantan Hospital, Beijing Red Cross Peace Orthopedic Hospital, and Beijing Puhua International Hospital. Methods: We retrospectively analyzed the effects of PRF on gasserian ganglion or its corresponding peripheral nerve as treatment for 85 patients with acute zoster-related TN under CT guidance between January 2008 to March 2021. The response criterion was a Numeric Rating Scale score reduction of > 50% at 12 weeks postoperatively. Univariable and multivariable analyses were performed to identify the predictive factors for a PRF positive response. Results: The medical records of a total of 85 acute zoster-related TN patients undergoing PRF treatment were identified and analyzed. The effective rate was 62.4% at 12 weeks postprocedure. Univariate analysis indicated that disease duration (P = 0.023), diabetes mellitus (P = 0.024), and treatment location (P= 0.013) were exposure factors for the analgesic efficacy of PRF treatment. On multivariable analysis, independent predictor of PRF positive response was the treatment location of the gasserian ganglion (odds ratio = 3.032; 95% confidence interval = 1.153-7.927; P = 0.024). Limitations: This was a retrospective study with a small sample size. Optimal PRF treatment parameters, as well as pain subtypes, need to be investigated in future studies. Conclusions: CT-guided PRF is an effective and safe treatment for acute zoster-related TN patients. Compared to peripheral nerve PRF, gasserian ganglion treatment may be more effective for patients with acute zoster-related TN.

Automated summary

PRF is a novel and safe technique for treating acute zoster-related TN, but there is limited research on its efficacy. This study aimed to investigate the analgesic effect of CT-guided PRF and explore determinants of therapeutic efficacy at multiple centers.