Comparative Efficacy of Pulsed Radiofrequency-Based and Related Interventions for Postherpetic Neuralgia: A Network Meta-Analysis of Randomized Controlled Trials.

OBJECTIVE

This study aimed to assess the effectiveness of 12 interventions for postherpetic neuralgia (PHN) through direct and indirect comparisons using a network meta-analysis. These interventions included pulsed radiofrequency (PRF), high-voltage pulsed radiofrequency (HPRF), Long-Term PRF (LPRF), selective nerve block (SVB), PRF combined with Nerve Block Therapy (PRF+SVB), spinal cord stimulation (SCS), PRF combined with drug therapy (PRF+drug), and other minimally invasive treatments.

DESIGN

A systematic search was conducted across PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and China National Knowledge Infrastructure (CNKI) to identify randomized controlled trials (RCTs) from inception to January 2026. Methodological quality was assessed using the Cochrane Risk of Bias tool, and data analysis was performed with Stata 15.1.

RESULTS

A total of 27 RCTs involving 1996 patients were included. Network meta-analysis showed that SCS significantly reduced Visual Analog Scale (VAS) scores (SUCRA: 77.3%, MD=3.17, 95% CI=1.74,4.60). PRF+drug ranked first in improving General Health (GH, SUCRA: 92.9%), Mental Health (MH, SUCRA: 100.0%), vitality (VT, SUCRA: 100.0%) scale scores, and reducing pregabalin dosage (SUCRA: 90.5%, MD=-387.08, 95% CI=-540.05,-234.10).

CONCLUSION

SCS is the optimal intervention for pain relief in PHN, while PRF+drug effectively improves quality of life and reduces medication burden. These findings provide evidence-based support for individualized PHN treatment.