CT-Guided Dorsal Root Ganglion Pulsed Radiofrequency Alone, with Ozone, or with Platelet-Rich Plasma for Postherpetic Neuralgia: A Randomized Controlled Trial.

BACKGROUND

Direct randomized evidence comparing dorsal root ganglion pulsed radiofrequency (PRF) alone, PRF plus ozone, and PRF plus platelet-rich plasma (PRP) for postherpetic neuralgia (PHN) remains limited.

OBJECTIVE

To compare the 90-day efficacy and safety of computed tomography-guided dorsal root ganglion PRF alone, PRF plus ozone, and PRF plus PRP in patients with PHN.

METHODS

This single-center randomized controlled trial was conducted at a pain-treatment center in Changzhi, China, from July to December 2025. Adults aged 50-70 years with single-segment PHN lasting >3 months were assigned 1:1:1 to PRF alone as the active control, PRF plus ozone, or PRF plus PRP. Outcomes were assessed at baseline and 30, 60, and 90 days. Outcomes included 10-cm Visual Analog Scale (VAS), Pittsburgh Sleep Quality Index (PSQI), 12-Item Short Form Health Survey (SF-12), and neutrophil-to-lymphocyte ratio (NLR). Longitudinal outcomes were assessed using mixed-effects models with Holm-Bonferroni-adjusted pairwise comparisons.

RESULTS

The complete-case/per-protocol population included 122 participants: 38 PRF alone, 43 PRF plus ozone, and 41 PRF plus PRP. Baseline characteristics were comparable. At 90 days, PRF plus PRP showed greater improvement in VAS than PRF alone and PRF plus ozone (mean differences, -2.49 [95% CI, -2.88 to -2.10] and -1.43 [-1.80 to -1.05]), PSQI (-5.72 [-7.09 to -4.36] and -4.77 [-6.09 to -3.44]), SF-12 (20.91 [17.44 to 24.38] and 17.72 [14.35 to 21.08]), and NLR (-0.89 [-1.30 to -0.47] and -1.00 [-1.40 to -0.59]); all adjusted P values were <0.001. No PRP-related complications were observed.

CONCLUSION

PRF plus PRP was associated with greater 90-day multidimensional improvement than PRF alone or PRF plus ozone. Given the single-center design, these results should be regarded as preliminary and require validation in larger, well-designed multicenter randomized trials.