Neuromodulation : journal of the International Neuromodulation Society · 2026
Temporary Spinal Cord Stimulation versus Dorsal Root Ganglion Pulsed Radiofrequency for Preventing Postherpetic Neuralgia: A Propensity-Score-Matched Real-World Study.
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Ke Penghui, Wang Likui, Song Yang, Xu Wenfeng, Xu Guang-Hong
Аннотация
OBJECTIVES: Postherpetic neuralgia (PHN) is the most disabling complication of herpes zoster, and first-line agents give only modest relief. Temporary spinal cord stimulation (SCS) and dorsal root ganglion pulsed radiofrequency (DRG-PRF) are increasingly used for PHN prevention, but head-to-head real-world evidence at standard DRG-PRF parameters is lacking. We compared temporary SCS with standard DRG-PRF for six-month PHN prevention.
MATERIALS AND METHODS: In this single-center retrospective cohort (2020-2025), patients with herpes zoster-related neuralgia refractory to conservative therapy received temporary SCS or standard DRG-PRF (42 °C, three 120-second cycles). We performed 1:1 propensity-score matching on 15 baseline covariates. The primary outcome was a six-month composite of persistent pain (numeric rating scale [NRS] ≥4) and sustained medication use. The primary estimand was the marginal odds ratio (OR) calculated using generalized estimating equations with matched-pair cluster-robust standard errors; an E-value assessed unmeasured confounding.
RESULTS: Among 181 matched pairs from a 445-patient analytic cohort, the six-month composite PHN end point was less frequent with SCS than DRG-PRF (marginal OR 0.52, 95% CI, 0.31-0.89, p = 0.02; number-needed-to-treat 8.2). The direction was consistent across predefined sensitivity analyses (OR range, 0.43-0.74); the E-value was 2.12. The benefit appeared concentrated in nonthoracic dermatomes (interaction p = 0.07). Periprocedural complication rates were similar (13.3% vs 14.9%; p = 0.63), with technique-specific adverse event profiles.
CONCLUSIONS: Temporary SCS was associated with lower six-month PHN incidence than standard DRG-PRF in this real-world cohort, with a consistent direction across sensitivity analyses. Multicenter prospective validation is warranted.
MATERIALS AND METHODS: In this single-center retrospective cohort (2020-2025), patients with herpes zoster-related neuralgia refractory to conservative therapy received temporary SCS or standard DRG-PRF (42 °C, three 120-second cycles). We performed 1:1 propensity-score matching on 15 baseline covariates. The primary outcome was a six-month composite of persistent pain (numeric rating scale [NRS] ≥4) and sustained medication use. The primary estimand was the marginal odds ratio (OR) calculated using generalized estimating equations with matched-pair cluster-robust standard errors; an E-value assessed unmeasured confounding.
RESULTS: Among 181 matched pairs from a 445-patient analytic cohort, the six-month composite PHN end point was less frequent with SCS than DRG-PRF (marginal OR 0.52, 95% CI, 0.31-0.89, p = 0.02; number-needed-to-treat 8.2). The direction was consistent across predefined sensitivity analyses (OR range, 0.43-0.74); the E-value was 2.12. The benefit appeared concentrated in nonthoracic dermatomes (interaction p = 0.07). Periprocedural complication rates were similar (13.3% vs 14.9%; p = 0.63), with technique-specific adverse event profiles.
CONCLUSIONS: Temporary SCS was associated with lower six-month PHN incidence than standard DRG-PRF in this real-world cohort, with a consistent direction across sensitivity analyses. Multicenter prospective validation is warranted.