Dual-neuromodulation strategy in pain management of herpes zoster ophthalmicus: retrospective cohort study and literature review

Figures & data

Figure 1. Surgical schematic of PNS implantation and PRF placement. (a) Anteroposterior view of fluoroscopic imaging. Red cycle indicated the foramen ovale; blue line indicated the mandibula; (b) depth of PRF cannulation was guided under the lateral view of the fluoroscopy.

Table 1. General characteristics of patients.

Group	PNS	PNS + PRF	p Value
N	20	13
Age (years)	70.25 ± 9.20	70.15 ± 9.00	.977
Sex (male/female)	11/9	7/6	>.999
Area (n, %)
V1 branch	15 (75%)	10 (77%)	>.999
V1–2 branch	5 (25%)	3 (23%)
Duration (n, %)
<1 month	2 (10%)	4 (31%)	.301
1–3 months	15 (75%)	7 (54%)
>3 months	3 (15%)	2 (15%)
Follow-up (n, %)
3-month	0	1 (8%)
6-month	7 (35%)	6 (46%)
12-month	13 (65%)	6 (46%)
Hospitalization duration (days)	16.15 ± 5.49	15.69 ± 3.65	.767
Implantation duration (days)	12.35 ± 1.96	11.91 ± 1.93	.564
VAS
Preoperative	7.5 ± 0.9	7.2 ± 1.4	.579
Last follow-up	2.05 ± 1.12	0.54 ± 0.75	.001
Anti-virus treatment
None	3 (15%)	3 (23%)	.658
Yes	17 (85%)	10 (77%)
Preoperative pain management (n, %)
Lidocaine path	3 (15%)	4 (31%)	.423
NSAIDs	9 (45%)	3 (23%)
Gabapentin/pregabalin	20 (100%)	13 (100%)
Opioids	13 (65%)	8 (62%)
Nerve block	12 (60%)	3 (23%)

Data are presented with mean ± standard deviation. PNS: peripheral nerve stimulation; PRF: pulsed radiofrequency; NSAIDs: non-steroidal anti-inflammatory drugs; VAS: visual analogue scale.

Figure 2. Pain severity assessed by the visual analogue score at each follow-up point. Patients were interviewed at baseline, discharge, 1-, 3-, 6- and 12 months after neuromodulation treatment. Two-way analysis of variance with repeated measures and Bonferroni’s post-test. ns = non-significant, *p < .05, **p < .01, ****p < .0001.

Table 2. Summary of enrolled literatures..

Author (year)	Country	No.	Age	Sex (F/M)	Pian duration	Intervention (target)	Aetiology	Clinical outcome	Follow-up
Manning et al. (2019)	UK	7	32–66	6/1	4–14 years	PNS (supraorbital or infraorbital branches)	Idiopathic TNP, PHN, postsurgical TNP	NRS, analgesic consumptions, side effects	3, 6 and 12 months
Wan et al. (2021)	China	68	65–93	37/31	15–90 days	PNS (supraorbital branch)	HZO	VAS, SF-36, analgesic consumptions	3, 7, 14, 30, 90 and 180 days
Han et al. (2020)	China	18	50–86	7/11	1–3 months	PNS (supraorbital branch)	HZO	VAS, response rate, analgesic consumptions, PHN incidence	1, 3, 6, 12 months
Liu et al. (2021)	China	26	69	14/12	1–4 months	PNS (supraorbital, maxillary branch or ramus of mandible skin field)	Herpes zoster-related TN	VAS, dosages of pain medication, PHN rate	1, 3, 6 months
Jakobs et al. (2016)	Germany	8	28–81	7/1	NR	PNS (infraorbital, supraorbital or mandibular nerve)	PHN, classical TN	VAS, attack frequencies, oral drug intake, complications and side effects	6–29 months
Johnson et al. (2004)	USA	10	33–86	3/7	7–144 months	PNS (supraorbital or infraorbital branches)	PHN, posttraumatic neuropathic pain	Complication rate, preoperative symptom duration, degree of pain relief, preoperative and postoperative work status, postoperative changes in medication usage and overall degree of therapy satisfaction	26.6 ± 4.7 months
Texakalidis et al. (2020)	USA	15	43–71	11/4	0.75–17 years	PNS (supraorbital and infraorbital nerve)	PHN, traumatic, post-stroke, idiopathic facial pain	VAS	5.8 months
Klein et al. (2015)	Germany	8	57–87	4/4	2–17 years	PNS (infraorbital, supraorbital, occipital or mandibular nerve)	Classical TN, PHN, idiopathic facial pain, multiple sclerosis, radiative injury	VAS, analgesic usage	11.3 months (5–28)
Taub et al. (1997)	Canada	34	NR	20/14	0.5–18 years	PNS (Gasserian ganglion)	Peripheral, central, PHN and unclassifiable	Success rate	6-month interval
Jia et al. (2022)	China	85	23–82	44/41	27–66 days	PRF (Gasserian ganglion, peripheral branch)	Acute zoster-related TN	NRS, response rate	1, 3 months
Ding et al. (2019)	China	90	52–91	48/42	NR	PRF (Gasserian ganglion, peripheral branch)	PHN	VAS, SF-36, efficacy rate, analgesic usage	1, 3, 6 and 12 months
Zhang et al. (2020)	China	36	73	17/19	NR	PRF (supraorbital nerve)	HZO	NRS, spontaneous pain, allodynia, gabapentin dosage, opioids usage, PGIC, Barrow numbness score, recurrence rate	30, 90, 180, 360 days
Fan et al. (2022)	China	106	67/69/67	34/72	NR	PNS (supraorbital and supratrochlear nerve), PRF (Gasserian ganglion)	HZO	NRS, PSQI, concomitant pain medication usage, relapse rate	1, 2, 4 weeks; 3, 6, 12 and 24 months
Liu et al. (2021)	China	32	56–86	12/20	0.5–3 years	PRF (ophthalmic branch of trigeminal nerve)	PHN	VAS, sleep quality, treatment satisfaction	1, 4, 12 weeks
Wan et al. (2019)	China	93	65	52/41	2 months	PRF (Gasserian ganglion)	Acute/subacute zoster-related TN	VAS, SF-36, pregabalin dosage	3, 7, 14 days; and 1, 3, 6 months
Wan et al. (2021)	China	115	70	71/44	2 months	PRF (Gasserian ganglion)	Acute/subacute zoster-related TN	VAS, SF-36, pregabalin dosage	3, 7, 14 days; and 1, 3, 6 months
Li et al. (2021)	China	52	64/66	30/22	2 months	PRF (supraorbital nerve)	PHN	VAS, SF-36, treatment efficiency	1, 4, 12 and 24 months
Li et al. (2022)	China	106	63/62	54/52	NR	PRF (Gasserian ganglion)	PHN	VAS, QoL, rescue drug dosage	3, 7, 14 days; and 1, 3, 6 months
Ding et al.(2019)	China	84	34–72	39/45	3–20 months	PRF (stellate ganglion)	PHN	VAS, QoL, PCS, MCS, efficacy rate	1, 2, 4, 12 and 24 weeks
Zhang et al. (2022)	China	91	67/66	47/44	3–360 months	PRF (DRGs)	PHN	VAS, tactile sensation, efficacy rate	3, 6, 12 months
Zhang et al. (2022)	China	64	63/66	31/33	50 days	PRF (corresponding spinal nerve segment and trigeminal nerve branches)	Herpes zoster neuralgia	VAS, PSQI, SAS, SDS, infrared thermograms, body area rating scale, morphine consumption, PHN incidence, serum inflammatory index	1, 3, 5 days; and 1, 2 months

DRG: dorsal root ganglion; HZO: herpes zoster ophthalmicus; MCS: mental component summary; NR: none reported; NRS: numerical rating scale; PCS: physical component summary; PHN: postherpetic neuralgia; PNS: peripheral nerve stimulation; PRF: pulsed radiofrequency; PSQI: Pittsburgh Sleep Quality Index; QoL: quality of life; SAS: Self-Rating Anxiety Scale; SDS: Self-Rating Depression Scale; SF-36: Short Form-36 Questionnaire; TN: trigeminal neuralgia; TNP: trigeminal neuropathic pain; VAS: visual analogue scale.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article.