BACKGROUND:Postherpetic neuralgia (PHN) is a challenging and persistent neuropathic pain condition that is often unresponsive to standard pharmacological treatments. Minimally invasive interventional therapies for PHN have been increasingly adopted in clinical practice. In recent years, low-temperature plasma ablation (LTPA) has demonstrated potential advantages and promising applications for managing chronic neuropathic pain. However, few studies have explored the use of LTPA in treating PHN. OBJECTIVES:To evaluate the effectiveness and safety of LTPA in treating PHN, with a focus on differences in outcomes among patients with varying durations of the disease. STUDY DESIGN:Retrospective cohort study. SETTING:Department of Pain Management, Xuanwu Hospital, Capital Medical University. METHODS:A retrospective analysis was conducted on 109 PHN patients treated with LTPA in our department from January 2023 to March 2024. Patients were categorized into 2 groups based on the duration of their disease: Group A (disease duration < 3 months) and Group B (disease duration >= 3 months). Pre-treatment pain levels were assessed using a Numeric Rating Scale (NRS), as were pain levels at one month and 3 months after treatment. Sleep quality was measured using the Medical Outcomes Study Sleep Scale (MOS-SS). Treatment efficacy was evaluated by comparing pre- and post-treatment data, with a reduction of at least 50% in NRS scores at 3 months after treatment considered the criterion for treatment success. The effective rates between the 2 groups were compared. Adverse events were recorded to assess the safety of the procedure. RESULTS:At all follow-up time points, NRS scores in both groups were significantly lower than pre-treatment scores (P < 0.05). At one and 3 months after treatment, Group A had significantly lower NRS scores (2.85 ± 1.89 and 2.74 ± 2.08) than did Group B (3.77 ± 1.91 and 3.71 ± 2.03, respectively; P < 0.05). The treatment success rate at 3 months after the treatment was significantly higher in Group A (78.72%) than in Group B (59.68%; P < 0.05). Both groups showed significant improvements from the pre-treatment MOS-SS sleep scores (in sleep disturbance [SLPD], sleep adequacy [SLPA], sleep quality [SLPQ], and comprehensive sleep disorder index [9-items]) at the one-month and 3-month follow-up points (P < 0.05), with no significant differences between the 2 groups at any time point after treatment. No severe adverse events were reported in either group during treatment or follow-up. LIMITATIONS:The single-center setting, relatively small number of patients, short duration of the review of medical records, and retrospective nature of the study. CONCLUSIONS:LTPA offers effective and sustained pain relief and sleep quality improvements for PHN patients and has a favorable safety profile.

BACKGROUND:Postherpetic neuralgia (PHN) is one of the most intractable pain disorders and often does not respond to medication, physical, and interventional procedures. Coblation technology has been demonstrated to have potential for neuralgia, but there are rare reports of the efficacy and security of coblation for PHN. The thoracic segment is the most common predilection part of PHN, so we conducted this long-term study to investigate the results of coblation for the treatment of thoracic PHN. OBJECTIVES:The aim of this study was to determine the efficacy and security of computed tomography (CT)-guided coblation of the thoracic nerve root for treatment of PHN. STUDY DESIGN:Self before-after controlled clinical assessment. SETTING:Department of Pain Management, Xuanwu Hospital, Capital Medical University. METHODS:Seventy-seven patients with thoracic PHN sustained for at least 6 months and refractory to conservative therapy were identified. Patients underwent CT-guided percutaneous coblation to ablate the thoracic nerve root for thoracic PHN. The therapeutic effects were evaluated using a Visual Analog Scale (VAS), medication doses, and pain-related quality of life (QoL) scale before coblation, and at 1 week, and at 1, 3, and 6 months after the procedure. Patients who achieved more than 50% pain relief were defined as responders. In addition, adverse effects were also recorded to investigate the security of this procedure. RESULTS:The VAS score significantly decreased from 7.22 ± 1.15 before the coblation to 3.51 ± 1.12 (P = 0.01), 3.02 ± 1.21 (P = 0.006), 3.11 ± 2.15 (P = 0.014), and 2.98 ± 2.35 (P = 0.008) at 1 week, and at 1, 3, and 6 months after the procedure, respectively. The number of responders were 56 (77.78%), 54 (75%), 55 (76.39%), and 54 (75%) at 1 week, and at 1, 3, and 6 months after the procedure, respectively. The doses of anticonvulsants and analgesics were decreased significantly at all time points after the procedure compared with before treatment (P < 0.05). Patient responses on the Brief Pain Inventory Short Form indicated mean scores that were significantly lower than baseline across all domains of pain interference with QoL at all evaluations (P = 0.001). Most of the patients had mild numbness and it did not affect the daily activities after the procedure. No other severe adverse events occurred during or after the procedure. LIMITATIONS:A single-center study, relatively small number of patients, short duration of review of medical record, and the retrospective study. CONCLUSIONS:CT-guided percutaneous thoracic nerve root coblation is an effective and safe method for the treatment of thoracic PHN, and the procedure can also significantly improve the QoL in patients with PHN.

INTRODUCTION:Although the sphenopalatine ganglion (SPG) has been considered a site of therapeutic potential for cluster headache (CH), the optimal technique of SPG is still to be determined. Low-temperature plasma radiofrequency ablation (LTPRA) has been proposed as an alternative treatment for several neuropathic pain diseases.AIM:To evaluate the effect of LTPRA of SPG in treating chronic and episodic CH.MATERIAL AND METHODS:The patients with CH, who achieved temporary pain relief following SPG block, treated using LTPRA between January 2015 and October 2017 were reviewed. Seventy-six patients were included: 50 patients suffered from episodic CH and the remaining 26 patients from chronic CH. The primary outcomes were clinical improvement rate, defined as the percentage of partial and complete pain relief results at 1 day, 12 months, and 24 months of follow-up after the operation.RESULTS:Clinical improvement rates were 92.3%, 92.3% and 73.1% in chronic CH and 73.1%, 84% and 68% in episodic CH at each follow-up time point, respectively. 3 chronic CH patients and 7 episodic CH patients showed no pain relief after the operation. Drooping eyelids were found in 2 cases, one recovered at the 3-month follow-up but another one did not in the 24-month follow-up. No serious complications occurred intraoperatively or postoperatively.CONCLUSIONS:LTPRA can be considered an effective and alternative surgical modality in treating patients with chronic and episodic CH, based on SPG block.

Background： Herpes zoster is a common disease mainly affect sensory nerves, but in this report sphenopalatine ganglion (SPG), mainly a parasympathetic ganglion was infected by the vesicular-zoster virus, with the performance of cluster headache. Case presentation: The patient underwent headache on left side orbit, supraorbital and temporal regions after infection of herpes zoster for 8 months, with lacrimation, conjunctival injection and nasal discharge. Pulsed radiofrequency of the SPG under ultrasound guidance was performed, we applied 2 cycles of PRF at 42℃for 120 seconds each time. Partial response lasted 1 month and the pain had recover to its baseline level. Low-temperature plasma radiofrequency ablation (coblation) technology is a relatively new technology that has shown promise in treating neuropathic pain. Then a CT-guided coblation of SPG was performed, used three of intensity for coblation (lasting for 30s, repeat twice) and six of intensity for coagulation (lasting for 30s, once). After coblation, the patient reported completed pain relief and autonomic symptoms disappeared without any side effects. The patient was satisfied with the effect on post-operative telephone follow-up performed on day 7, month 1 and month 3, pain VAS score remained on 0/10. Conclusions: Our report demonstrates that coblation technology is succeseful treatment for cluster headache in this case, but this finding still needs additional studies for confirmation. Key words: cluster headache, coblation, herpes zoster

目的 探讨不同术式CT引导下经皮三叉神经半月节低温等离子消融治疗中老年原发性三叉神经痛(ITN)的效果.方法 选取60例＞50岁ITN患者,随机分为A、B组各30例,均行半月节低温等离子消融术;A组采用定时模式,B组采用定效模式.记录2组术前和术后1天、7天、1个月、6个月时疼痛数字量表(NRS)评分,术后6个月时统计面部麻木分级及相关并发症.结果 2组均成功进行手术,术后各时间点NRS评分均小于术前(P均＜0.05),A组术后1个月和6个月时NRS评分均高于B组(P均＜0.05).A组术后6个月时面部麻木分级[(1.03±0.62)级]低于B组[(2.00土0.79)级,P＜0.05].2组主要不良反应均为口腔溃疡、咀嚼肌肌力减退、温度觉敏化、颞下颌关节紊乱、耳鸣、面部深感觉减退、眼部症状,组间各种并发症发生率差异均无统计学意义(P均＞0.05).结论 定时模式及定效模式CT引导下经皮三叉神经半月节低温等离子消融术治疗中老年ITN效果均较好,术后麻木感均较轻.

BACKGROUND:Herpes zoster (HZ) is associated with inflammation of the peripheral nerves, which is considered to be an important cause of postherpetic neuralgia (PHN). Interventions aimed at reducing this inflammation could prevent PHN. One option is the epidural administration of corticosteroid and local anesthetic. However, several authors have reported a risk of arachnoiditis with epidural corticosteroids. Subcutaneous injection in an outpatient setting is a safer option. However, there is limited evidence of the effectiveness of this alternative for preventing PHN. OBJECTIVES:The aim of this study was to assess the effectiveness of subcutaneous injection of triamcinolone and lidocaine for the prevention of PHN in elderly HZ patients. STUDY DESIGN:Randomized, single-center, clinical trial. SETTING:Department of pain management of a teaching hospital in Beijing, China. METHODS:Patients with acute HZ with rash < 7 days (n = 100) were randomly assigned to receive either standard therapy (oral antivirals and analgesics) alone or standard therapy plus subcutaneous injection of triamcinolone and lidocaine. The severity of pain was assessed using a numeric rating scale (NRS) at enrollment and at one, 3, and 6 months after rash onset. Quality of life (QoL) was evaluated by the SF-36 before treatment and at 3 and 6 months after rash onset. The primary endpoint was the presence of zoster-associated pain (ZAP) at 3 months after rash onset. RESULTS:At enrollment, all patients reported ZAP with average NRS scores of 6.64 ± 1.44 and 7.16 ± 1.22 in the standard group and subcutaneous group, respectively. At 3 and 6 months after rash onset, the pain had decreased in both groups, but the decrease was significantly greater in the subcutaneous injection group. At 3 months, 2 (4%) patients in the subcutaneous injection group vs. 10 (20%) patients in the standard group had ZAP with NRS > 3 (P = 0.014). Both groups showed significant improvement in QoL at 3 and 6 months. No patient had major adverse events related to the subcutaneous injection. LIMITATIONS:The main limitation of the study was the absence of a placebo subcutaneous injection in the standard group. CONCLUSION:Subcutaneous injection of triamcinolone and lidocaine in the acute phase of HZ can reduce ZAP more effectively than oral antivirals and analgesics alone, and may be a feasible method to prevent PHN. KEY WORDS:Subcutaneous injection, lidocaine, triamcinolone, postherpetic neuralgia, prevention.

Objective To observe the efficacy and safety of repetitive transcranial magnetic stimulation( rTMS)in treating idiopathic trigeminal neuralgia( ITN). Methods From December 2013 to December 2014,the study enrolled 40 patients who were definitely diagnosed with ITN in the Department of Pain Management,Xuanwu Hospital Capital Medical University. Using random number table method,the patients were divided into gabapentin group and rTMS group,20 in each group. General data of the patients were recorded, including gender, age, duration of disease, lesion side and lesion branch. The VAS score and the number of patients with VSA score < 4 were recorded before treatment,in week 2(T1),week 5 (T2),month 1(T3),month 3(T4)and month 6(T5)after treatment. The dosages of gabapentin and the pain remission rate at T1, T2, T3, T4 and T5 were recorded, and adverse reactions such as somnolence and dizziness at T5 were also observed. Results The two groups were not significantly different in gender,age,duration of disease,lesion side and lesion&nbsp;branch( P > 0. 05 ) . One patient in gabapentin group terminated treatment and was excluded from the study due to the ineffectiveness of gabapentin. There was no interaction between treatment method and treatment time for VAS score(P > 0. 05);treatment method had no marked main effect on VAS score(P > 0. 05);treatment time had marked main effect on VAS score(P< 0. 05). The two groups were not significantly different in VAS score at different time points(P > 0. 05). The two groups had lower VAS scores at T1,T2,T3,T4 and T5 than those before treatment(P < 0. 05). Before treatment,there were no patients with VAS score < 4 in the two groups. After treatment,the two groups were not significantly different in the incidence of VAS score< 4 at different time points(P > 0. 05). The two groups of patients were significantly different in the dosage of gabapentin at different time points after treatment(P < 0. 05). The two groups were not significantly different in pain remission rate at different time points after treatment( P > 0. 05). rTMS group was lower than gabapentin group in the incidence rates of dizziness and somnolence after treatment(P < 0. 05). Conclusion rTMS can effectively relieve idiopathic trigeminal neuralgia,and it is a safe and effective method of noninvasive physical therapy.

BackgroundPatients with thoracic neuropathic pain often do not respond to medication and physical therapy. Coblation technology has been demonstrated to have potential for pain management.MethodsFifteen patients underwent computed tomography-guided percutaneous coblation to ablate the thoracic paravertebral nerve for their medication-resistant thoracic neuropathic pain. The pain intensity was assessed by visual analog scale (VAS) 1 day before surgery and 1 week and 1, 3, and 6 months after surgery, and the difference between preoperative and postoperative VAS values was determined to evaluate the pain relief effectiveness. Patients who achieved > 50% pain relief were defined as responders, and the ratio in all patients was calculated. The number of patients who reported mild pain (VAS 3) was recorded, and the ratio in all responders was calculated. In addition, adverse effects were also recorded to investigate the security of procedure.ResultsTwelve (80%) responders achieved > 50% pain relief. The VAS score of responders significantly decreased from 7.42 1.38 before surgery to 2.17 +/- 1.11 (P = 0.000), 1.92 +/- 1.16 (P = 0.000), 1.75 +/- 0.97 (P = 0.000), and 1.58 +/- 1.08 (P = 0.000) at 1 week, 1, 3, and 6 months after surgery, respectively. The number of responders with mild pain was 10 (83.3%), 11 (91.7%), 12 (100%), and 12 (100%) at 1 week, 1, 3, and 6 months after surgery, respectively. All responders and 1 nonresponder reported slight numbness after the surgery.ConclusionPercutaneous thoracic paravertebral nerve coblation guided by computed tomography is a potential method for the treatment of thoracic neuropathic pain.

AbstractThe aim of this study was to investigate the long-term results of computed tomography (CT)-guided percutaneous radiofrequency thermocoagulation (PRT) for glossopharyngeal neuralgia (GPN).A retrospective review of medical records for patients with GPN who were treated with CT-guided PRT between 2003 and 2014 was performed to investigate baseline characteristics and immediate outcomes during the hospitalization. Long-term pain relief outcomes and complications were obtained via telephone survey. Duration of pain-free was assessed by Kaplan–Meier analysis.Eighty patients with GPN were treated with CT-guided PRT, and 71 patients could be contacted for the follow-up. The mean length of follow-up after PRT was 56.2 ± 43.3 months. Pain relief occurred in 63 patients (78.8%) immediate after the PRT procedure. The percentage of patients who remained in an “excellent” or “good” pain relief condition was 73.2%, 63.0%, 53.2%, and 43.0% at 1, 3, 5, and 10 years. Postprocedure complication included dysesthesias, dysphagia, and diminished gag reflex. No mortality was observed during or after PRT procedures.This study indicates that CT-guided PRT is a safe and effective method for patients with GPN and should be considered as an alternative treatment for these patients.

OBJECTIVE:Our previous study evaluated the effectiveness and safety of radiofrequency thermocoagulation (RFT) of trigeminal gasserian ganglion for idiopathic trigeminal neuralgia (ITN). The aim of this study was to evaluate the optimal radiofrequency temperature of computed tomography (CT)-guided RFT for treatment of ITN. METHODS:A retrospective study of patients with ITN treated with a single CT-guided RFT procedure between January 2002 and December 2013. Patients were divided into ≤75 °C, 75 °C, and ≥80 °C groups according to the highest radiofrequency temperature used. Pain relief was graded from poor to excellent, and facial numbness/dysesthesia from I (absent) to IV (most severe). RESULTS:A total of 1161 RFT procedures were undertaken in the 1137 patients. The mean follow-up time was 46 ± 31 months. There were no significant differences in the rate of excellent pain relief according to the radiofrequency temperature used. However, more patients experienced with no facial numbness or facial numbness gradually resolved and those patients treated at 75 °C had a lower rate of grade IV facial numbness/dysesthesia than other groups. CONCLUSIONS:The optimal radiofrequency temperature to maximize pain relief and minimize facial numbness or dysesthesia may be 75 °C, but this requires confirmation.

BACKGROUND:There is currently no reliable treatment for stump pain and phantom limb pain. Peripheral factors play a significant role in the pathophysiology of stump pain and phantom limb pain. Coblation technology is a relatively new technology that has shown promise in treating neuropathic pain.CASE REPORT:This report describes the use of coblation technology on femoral and sciatic nerve for stump pain and phantom limb pain. An ultrasound-guided perineural infiltration anesthesia surrounding the neuroma was first performed and achieved approximately 60% stump pain relief that lasted for 2 hours, but no relief of the phantom limb pain. An ultrasound-guided femoral and sciatic nerve block was performed to obtain longer pain relief. The patient reported approximately 80% pain relief in both stump pain and phantom limb pain that lasted for 40 hours. This finding suggested other factors in addition to the ultrasound-detected neuroma in the residual limb generating pain for this patient. Coblation of femoral and sciatic nerves was performed. The stump pain was completely relieved immediately after operation. At 1, 3, and 6 months postoperative review, 80% relief of both stump and phantom limb pain was achieved. Overall activity was improved and there was no need for pain medications. The analgesic effect was stable during the 6-month follow-up period.CONCLUSION:Our report suggests that coblation technology may be useful treatment for stump pain and phantom limb pain. Treatments focusing on peripheral nerves may be more effective than those focusing on the neuroma. This finding needs additional study for confirmation.

This article evaluates the long-term outcomes of computed tomography (CT)-guided percutaneous radiofrequency thermocoagulation (PRT) for patients with recurrent trigeminal neuralgia (TN) after microvascular decompression (MVD).This is a retrospective study of 41 patients with intractable TN who after MVD underwent CT-guided PRT procedures between 2002 and 2012.The mean length of follow-up after PRT was 44.4 months. Immediate pain relief was in 37 patients (90.2%); the percentage of patients who remained in "excellent" or "good" pain relief condition after CT-guided PRT procedure was 85% at 1 year, 80% at 2 years, 51% at 5 years, and 41% at 10 years. Six patients received the second PRT and all achieved "excellent" or "good" pain relief. In total, 34 of these patients (82.9%) received multi-PRT procedure and remained satisfied with their pain relief during the follow-up period. Postoperative complications included facial numbness in 36 patients, limited eyes opening in 1 patient, ear paresthesia in 1 patient, no tears in 1 patient, and taste hypesthesia in 1 patient; these symptoms were all improved in the process of follow-up and their life had not severely affected. No mortality was observed during and after CT-guided PRT procedures.CT-guided PRT should be considered as an alternative treatment for patients with recurrent TN after MVD.