The efficacy of ultrasound-guided spinal nerve posterior ramus pulsed radiofrequency treatment for aged lower back post-herpetic neuralgia

• Published in: Zhong hua yi xue za zhi Vol. 98; no. 10; p. 733
• Main Authors: Pi, Z B, Zhang, J K, Peng, Y, Jin, Y, Lin, H
• Format: Journal Article
• Language: Chinese
• Published: China 13.03.2018
• Subjects: Humans; Morphine; Neuralgia; Pain Measurement; Pulsed Radiofrequency Treatment; Spinal Nerves; Herpes zoster; Ultrasonography, doppler, pulsed; Neuralgia
• ISSN: 0376-2491
• DOI: 10.3760/cma.j.issn.0376-2491.2018.10.004

To evaluate the efficacy of ultrasound-guided spinal nerve posterior ramus pulsed radiofrequency treatment of lower back post-herpetic neuralgia. One hundred and twenty-eight cases of lower back or anterior abdominal wall acute post-herpetic neuralgia patients were enrolled. They were randomly divided into two groups. Group A: oral treatment only with gabapentin+ celecoxib+ amitriptyline. Group B: while taking these drugs, patients were treated with radiofrequency pulses using a portable ultrasound device and the paravertebral puncture technique.In both groups, sudden outbreaks of pain were treated with immediate release 10 mg morphine tablets. Before and one week, two weeks, four weeks, eight weeks after treatment, visual analogue scale (VAS) was used for pain score, Pittsburgh sleep quality index scale (PSQI) was used to evaluate sleep quality, and morphine consumption was recorded. Eight weeks after treatment analgesic efficacy was evaluated. Treatment efficiency and significant efficiency was calculated while the occurrence of complications were documented. In the control group, the VAS of T T T and T were 6.7 ±1.2, 5.2 ± 1.0, 3.3 ±1.1, 3.0±0.9.However, at the same time points, the VAS in the treatment group were 3.1±1.0, 2.2±0.7, 1.4±0.5, 1.2±0.5, respectively.The radio frequency group decreased significantly compared with the control group, the difference was statistically significant ( =17.925, 19.662, 12.580, 13.987, all <0.05). Four weeks after treatment, the TNF-α in the control group was (11.04±2.36)ng/L, and the TNF-β in the radio frequency group was (8.07±2.13) ng/L. After the treatment, the TNF-α of the radio frequency group was lower than the control group, and the difference was statistically significant ( =-6.267, <0.05). The IL-1β in the control group was (3.47±1.09) ng/L after treatment.The IL-1β in the radio frequency group was (1.96 ±0.56) ng/L, the IL-1β in the radio frequency group was lower than the control group and the difference was statistically significant ( =-8.266, <0.05). Pearson correlation analysis showed that before and after the treatment of TNF-α were positively correlated with VAS score ( =0.455, 0.327, all <0.05). IL-1β before and after treatment were positively correlated with VAS score ( =0.369, 0.357, all <0.05). At T T T and T , PSQI in the control group were 8.5±1.5, 7.3±1.4, 6.2±1.3 and 6.0±0.9 respectively.PSQI in the radio frequency group at the same time points were 6.5±1.4, 5.1±1.2, 4.0±1.1 and 3.9±0.5.Comparison between the two groups after treatment, radio frequency group was lower than the control group significantly, and the difference was statistically significant ( =7.798, 9.545, 10.335, 16.318, all <0.05). Morphine consumption of the control group at T T T T were (22.5±2.2), (15.5±2.9), (6.8±1.5) and (4.2±0.9)mg.However, morphine consumption of the radio frequency group were (13.2±2.5), (7.2±2.7), (3.2±0.6) and (2.2±0.5)mg.Comparison between the two groups after treatment, morphine consumption of the radio frequency group decreased significantly than the control group, and the difference was statistically significant ( =22.341, 16.758, 17.827, 15.541, all <0.05). During the operation , no error occurred with needle penetrating the abdominal cavity, chest, offal or blood vessels. Ultrasound-guided spinal nerve posterior ramus pulsed radio frequency treatment of lower back or anterior abdominal wall post-herpetic neuralgia proves effective and can reduce patient morphine usage and lead to fewer adverse reactions.