Comparative long-term efficacy of short-term spinal cord stimulation versus bipolar pulsed radiofrequency for refractory postherpetic neuralgia: a 24 month prospective study

Postherpetic neuralgia (PHN) is a debilitating neuropathic pain condition that persists after herpes zoster infection, often resistant to conventional medications. This study compares the long-term efficacy and safety of short-term spinal cord stimulation (stSCS) versus bipolar pulsed radiofrequency (bPRF) in managing refractory PHN.

In this prospective, controlled observational study, 140 PHN patients (aged ≥ 18 years; PHN duration ≥ 3 months) with inadequate pain relief from standard therapies were enrolled and randomized equally into two groups (n = 70 each). The stSCS group received percutaneous implantation of an 8-contact electrode for temporary neuromodulation, while the bPRF group underwent application of controlled high-frequency pulses to the dorsal root ganglion. Outcome measures included pain intensity (VAS, NRS), neuropathic pain characteristics (DN4), quality of life (SF-36, EQ-5D), sleep quality (PSQI), and psychological status (SAS, SDS), assessed at baseline and at follow-up intervals over 24 months.

Both stSCS and bPRF achieved significant short-term pain relief. However, from 6 to 24 months post-treatment, the stSCS group demonstrated significantly lower VAS scores and superior pain control compared to the bPRF group. In addition, improvements in sleep quality and emotional well-being were more pronounced in the stSCS group at 12, 18, and 24 months. Both treatments exhibited favorable safety profiles with only minor, transient adverse events reported.

While both stSCS and bPRF effectively alleviate pain in patients with refractory PHN, stSCS offers superior long-term benefits in pain reduction, sleep quality, and psychological outcomes. These findings suggest that stSCS may be the preferred neuromodulation strategy for patients with chronic PHN requiring sustained symptom management.