The Effect of Esketamine Combined with Pulsed Radiofrequency on Neuropathic Pain in Herpes Zoster Patients: A Randomised Clinical Trial.

INTRODUCTION

Zoster-related neuralgia (ZRN) remains challenging to treat with current analgesics and interventional therapies. Esketamine, an N-methyl-D-aspartate receptor antagonist, offers potent analgesic effects. This study evaluated the efficacy and safety of low-dose esketamine combined with pulsed radiofrequency (PRF) for ZRN.

METHODS

In this randomized controlled trial, 60 patients with ZRN scheduled for PRF were assigned to receive either continuous esketamine (0.02 mg/kg/h for 48 h) or saline alongside standard PRF and anticonvulsants. Pain (NRS, ID-pain), anxiety (HAMA), depression (HAMD-24), sleep quality (PSQI), and dissociative symptoms (CADSS) were assessed at baseline (T0), 48 h post-treatment (T1), 48 h post-treatment (T1), 1 week (T2), 2 weeks (T3), 1 month (T4), and 3 months (T5) post-treatment. Vital signs, CADSS scores (measuring dissociative symptoms), and other relevant clinical data were recorded at pre-medication (t0), 1 h (t1), 12 h (t2), 24 h (t3), and 48 h (t4) post-medication.

RESULTS

Sixty patients completed the study. The esketamine group showed significantly lower NRS and ID-pain scores at all post-treatment time points (P < 0.01). HAMD-24 and PSQI scores were significantly improved from 48 h through 12 weeks (P < 0.05), while HAMA scores improved significantly from 1 week onward (P < 0.05). No significant differences in CADSS scores or adverse events were observed between groups.

CONCLUSION

Low-dose esketamine combined with PRF provides effective pain relief and improves mood and sleep quality in ZRN patients with a favorable safety profile.

TRIAL REGISTRATION: ChiCTR2400093061.