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.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
In my institution, this therapy, if it is even offered at all, is most certainly not in the PCP domain. So, I don't know whether this is newsworthy in a larger sense, but to our PCP practice it is not.
, McMaster University