Home-Based Remote Programming versus Inpatient Programming After Short-Term Spinal Cord Stimulation for Herpes Zoster...

Short-term spinal cord stimulation (st-SCS) is increasingly used for acute and subacute herpes zoster neuralgia (HZNP), but postoperative management typically requires prolonged hospitalization. We compared two management strategies-continuous inpatient programming versus early discharge with remote programming-on pain outcomes, patient-reported outcomes, safety, and costs.

This single-center retrospective cohort study included 28 patients with HZNP (disease duration ≤3 months) who underwent percutaneous st-SCS between May 2021 and May 2024. Fourteen patients received inpatient programming throughout the stimulation period; 14 were discharged 1-2 days post-implantation with remote parameter adjustment. Pain (VAS), sleep (PSQI), anxiety/depression (HADS), quality of life (SF-36), opioid consumption (MME), complications, and costs were assessed preoperatively, at electrode removal, and at 3, 6, and 12 months.

Both groups achieved substantial pain relief after st-SCS (time effect P<0.001). Between-group differences in VAS scores were less than 0.5 points at all postoperative time points-well below the minimal clinically important difference of approximately 2 points-indicating comparable analgesic efficacy regardless of programming setting (group effect P=0.325; group×time interaction P=0.902). At 3 months, the home group had numerically lower PSQI (5.8±1.3 vs 7.1±1.5) and HADS scores (6.2±1.8 vs 7.8±2.1) and higher SF-36 scores (78.4±6.2 vs 72.5±6.8), but these differences did not survive Bonferroni correction. Opioid consumption was lower in the home group at 3 months (13.2±4.0 vs 18.0±4.2 mg/day, P=0.005). Complication rates were similar (14.3% each). Total healthcare costs were 28.5% lower in the home group (9464±938 vs 13,236±1499 CNY, P<0.001), driven primarily by reduced bed and nursing fees from shorter hospitalization.

For patients with HZNP treated with st-SCS, early discharge with remote programming achieved analgesic results comparable to inpatient management-both in statistical terms and, more importantly, in clinical magnitude-while reducing opioid use and healthcare costs. The cost advantage reflects shorter hospital stay rather than superior analgesia. These findings support remote programming as a practical alternative for appropriately selected patients, though confirmation in larger prospective studies is needed.