Dual-neuromodulation strategy in pain management of herpes zoster ophthalmicus: retrospective cohort study and literature review

Background Effective pain control of herpes zoster ophthalmicus (HZO) is not only essential to attenuate the clinical symptoms but to reduce the risk of postherpetic neuralgia development. Recently, neuromodulation therapy has been one promising option for neuropathic pain and increasingly applied in management of zoster-related pain. One key factor of neuromodulation treatment is the therapeutic site for the impaired nerves. In this study we aim to investigate one novel dual-neuromodulation strategy, targeting the level of the peripheral branch and trigeminal ganglion, in the pain management of HZO.Methods Dual neuromodulation strategy combining short-term peripheral nerve stimulation (PNS) with pulsed radiofrequency (PRF) of trigeminal ganglion was compared with single PNS treatment for HZO-related pain. Clinical recordings of patients were retrospectively reviewed. The primary outcome was the pain severity, assessed by the visual analogue scale (VAS) before and after neuromodulation therapy.Results PNS achieved significant relief of pain with or without PRF treatment before discharge, which provided enduring therapeutic effect up to 12-month follow-up. The mean reduction of VAS was 6.7 +/- 1.4 in dual modulation therapy (n = 13) at last follow-up and 5.4 +/- 1.5 in PNS subgroup (n = 20), respectively. Moreover, dual modulation strategy provided better control of pain compared with PNS therapy alone at each time point.Conclusion It is feasible and effective to combine the PNS and PRF in pain management of HZO. This novel dual modulation strategy of trigeminal pathway may provide additional therapeutic effects of pain symptoms in HZO population. Dual neuromodulation strategy for pain management of herpes zoster ophthalmicus is proposed, with regard to stimulation site (peripheral and trigeminal ganglion) and apparatus (electrical nerve stimulation and pulsed radiofrequency). Superior clinical outcome was associated with novel neuromodulation therapy with dual therapeutic targets, when compared with peripheral nerve stimulation in treatment of herpes zoster ophthalmicus. We conducted literature review to compare distinct pattern of neuromodulation (peripheral nerve stimulation and radiofrequency) in treatment of trigeminal neuropathic pain caused by herpes zoster.