Efficacy of Pulsed Radiofrequency Combination Therapy for Postherpetic Neuralgia: A Systematic Review and Bayesian Network Meta-Analysis.

BACKGROUND

Postherpetic neuralgia (PHN) lowers quality of life. However, the comparative efficacy of pulsed radiofrequency (PRF)-based combination therapies remains unclear. This study compared different PRF combination regimens for PHN.

METHODS

Eight databases were searched up to July 25, 2025. Risk of bias was assessed using the Cochrane RoB 2 and the Newcastle‑Ottawa Scale. Pain was the primary outcome; sleep, anxiety, and depression were secondary. A Bayesian network meta‑analysis was performed in R (version 4.4.1), with effect sizes expressed as mean differences (MDs) or standardized mean differences (SMDs), alongside 95% credible intervals (CrIs) and surface under the cumulative ranking curve (SUCRA) values.

RESULTS

Seventeen studies were included. For pain relief, PRF + radiofrequency ablation (RFA) (MD = -2.1, 95% CrI: [-2.7, -1.5], SUCRA = 0.96) was the optimal regimen at one week, while PRF+glucocorticoid (GC) was superior at around one month (MD = -2.3, 95% CrI: [-2.6, -1.9], SUCRA = 0.96) and at three months (MD = -2.3, 95% CrI: [-2.7, -2.0], SUCRA = 0.97). Regarding sleep, PRF + intravenous lidocaine infusion (SMD = -9.2, 95% CrI: [-11, -7.5], SUCRA = 0.99) was most effective at one week, whereas PRF+duloxetine (SMD = -1.5, 95% CrI: [-2.0, -1.1], SUCRA = 0.98) was superior at three months. Anxiety was most effectively alleviated by PRF + intravenous lidocaine infusion (SMD = -1.6, 95% CrI: [-2.1, -1.0], SUCRA = 0.94). PRF+duloxetine (SMD = -2.5, 95% CrI: [-3.1, -2.0], SUCRA = 0.99) was the optimal combination for mitigating depression.

CONCLUSION

PRF+RFA may be the optimal combination for pain relief at one week, and PRF+GC appears more effective at around one month and over longer follow-up. Lidocaine infusion may benefit sleep at one week and anxiety, while duloxetine may enhance longer-term sleep and alleviate depression. Additional trials are warranted.

TRIAL NUMBER: CRD420251155850.