Evaluation of the efficacy and safety of combined pulsed radiofrequency and transforaminal epidural steroid injection in herpes zoster-related pain

Objectives: In this study, we aimed to evaluate the effectiveness of pulsed radiofrequency (PRF) and transforaminal anterior epidural steroid injection (TFAESI) applied to the dorsal root ganglion (DRG) in herpes zoster pain.
Methods: The results of patients who underwent DRG PRF and TFAESI for herpes zoster-related pain in the algology clinic were evaluated retrospectively. Demographic and clinical examination findings (gender, age, involved dermatome, side, neurologic examination, medications used), VAS scores, and complications were recorded at 1, 6, and 12 months after the procedure.
Results: Data of 93 patients were evaluated. Sixty-six patients were in the acute/subacute pain phase, while 27 patients had postherpetic neuralgia (PHN) at presentation. Eleven patients (C2–4: 1, C3–5: 2, C4–6: 2, C5–7: 2, C6–8: 2, C7–T1: 2) underwent cervical DRG PRF and TFAESI. Seventy-five patients underwent thoracic DRG PRF and TFAESI (T1–3: 2, T2–4: 6, T3–5: 4, T4–6: 11, T5–7: 9, T6–8: 9, T7–9: 6, T8–10: 5, T9–11: 9, T10–12: 7, T11–L1: 3, T12–L2: 4). Seven patients underwent lumbar DRG PRF and TFAESI (L1–3: 3, L2–4: 1, L5–S2: 3). VAS scores for all three regions were significantly lower than pre-procedure scores at 1, 6, and 12 months after the procedure (p<0.001, p<0.001, p=0.008, respectively). While 2 patients developed nausea and dizziness due to subdural and intravenous leakage after the procedure, no fatal complications were recorded in any patient.
Conclusion: In herpes zoster-associated refractory neuropathic pain, fluoroscopy-guided combined DRG and TFAESI application methods provide long-term effective pain control and are safe both in the acute/subacute phase and in patients who develop PHN.