High-Voltage Pulsed Radiofrequency Neuromodulation as Monotherapy for Postherpetic Neuralgia: A Case Report.

BACKGROUND

Postherpetic neuralgia (PHN) management remains suboptimal, and many patients rely on systemic medications with limited efficacy and tolerability, particularly in older adults. Pulsed radiofrequency (PRF) is used as a neuromodulatory option, but optimal dosing parameters remain uncertain.

CASE REPORT: A 72-year-old patient with refractory thoracic PHN (Visual Analog Scale [VAS] 8/10, 5-week duration) underwent computed tomography (CT)-guided PRF at the T4-T5 dorsal root ganglia (DRG) using escalated parameters (90 V, 45°C, 20-millisecond pulse width, 10-minute duration). No perineural injectates or pharmacologic adjuvants (e.g., corticosteroids, long-acting local anesthetics, or neurotrophic agents) were used; only a small amount of 1% lidocaine was used for skin infiltration. Immediate pain reduction to VAS 3/10 was achieved, progressing to 1/10 at one month. Gabapentin and lidocaine patches were discontinued after the procedure, with an 85% reduction in dermatomal hypersensitivity. No sensory deficits or complications were observed during follow-up.

CONCLUSIONS

Our case provides hypothesis-generating evidence that CT-guided, high-parameter PRF (90 V, 45°C, 20 milliseconds, 10 minutes) delivered to the thoracic DRG can be associated with substantial short-term pain relief in subacute PHN without adjunct pharmacotherapy. Given the single-patient, uncontrolled design and one month follow-up, the findings should be interpreted cautiously and require confirmation in prospective studies with longer observation.