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

Abstract

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. 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. Retrospective, multicenter, observational clinical study. The study was conducted at pain management centers in Beijing Tiantan Hospital, Beijing Red Cross Peace Orthopedic Hospital, and Beijing Puhua International Hospital. 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. 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). 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. 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.