Clinical Efficacy Of Dorsal Root Ganglion Pulsed Radio Frequency Combined With Platelet Rich Plasma In Patients With Post Herpetic Neuralgia

ObjectivePostherpetic neuralgia(PHN),is the most common complication of herpes zoster.Oral drug treatment has limited efficacy and relatively large side effects.At present,dorsal root ganglion pulsed radiofrequency minimally invasive intervention is mostly used in China.In addition,a large number of domestic and foreign studies have shown the effects of platelet rich plasma injection therapy for nerve repair.This study investigated the efficacy of conventional pulsed radiofrequency therapy in combination with platelet rich plasma injection for the treatment of post herpetic neuralgia of the thoracic region,to observe whether there is any difference between the two methods,and to explore the clinical significance of developing combination therapy.MethodsThis study used a randomized controlled clinical study,Patients with postherpetic neuralgia who were hospitalized in the Department of pain,the east part of Qingdao Municipal Hospital,from January 2020 to December 2021 were collected,and the subjects were selected strictly according to the inclusion and exclusion criteria,and a total of 60 individuals were included in this study.The 60 subjects were divided into two groups according to the random number method,They were treated by pulsed radio frequency of dorsal root ganglion alone(radio frequency alone group)or pulsed radiofrequency of dorsal root ganglion combined with platelet rich plasma injection(combined group).Among them,in the radiofrequency alone group,puncture was completed at the corresponding segment under DSA guidance,and pulsed radiofrequency treatment was performed after the test of connected pulse radiofrequency instrument and accurate positioning.In the combination therapy group,8 ml of blood from the antecubital vein of the patients was centrifugally stratified on the basis of pulsed radiofrequency,and the middle platelet rich plasma layer was injected around the dorsal root ganglia by radio frequency needle.Visual analog scale(VAS)for pain,Pittsburgh sleep quality index(PSQI),and mean temperature difference between the lesional and the corresponding contralateral areas on infrared thermography were recorded for both groups before treatment and at 1day,3days,7days,1month,and 3 months after treatment(△T℃),comparing the difference in effect between the two groups.Result(1)Sixty subjects were included in this study,30 in each of the radiofrequency alone group and the combination group.There were no significant differences when comparing several aspects including gender,age,disease duration,hypertension and diabetes(all P>0.05).(2)Pre treatment VAS,PSQI,△T℃,none of the differences were statistically significant(all P>0.05).(3)The VAS scores after treatment were significantly different(P < 0.05)when compared with those before surgery at each time point within the two groups.The difference between the two groups,at each time point,was lower in the combination therapy group than in the radiofrequency alone group(P<0.05).(4)Post treatment PSQI scores were statistically significantly different when compared with preoperative values at each time point within the two groups(P<0.05).There was no significant difference in the PSQI index scores at 1,3,or 7 days between the two groups(P>0.05),and they were lower in the combination therapy group than in the radiofrequency alone group at 1 and 3 months(P<0.05).(5)There was no significant difference in the skin temperature of healthy side area within and between groups at each time point(P > 0.05);There were no statistically significant differences within or between groups at each time points of the lesional skin area(P>0.05).(6)The difference in △T℃ between the two groups on postoperative days 1,3,and 7was little changed compared with that before the operation,and there was no significant difference(P > 0.05).Differences were noted between the combination group at 1 and 3months after treatment compared with preoperative(P < 0.05).There was always no significant difference in the radiofrequency alone group.(7)The overall incidence of adverse effects did not differ between the two groups.Conclusion(1)DSA guided pulsed radiofrequency of dorsal root ganglia combined with PRP injection is effective in the treatment of postherpetic neuralgia.It is better than pure dorsal root ganglion pulse radiofrequency therapy.(2)PRP has the effect of nerve repair in the injured skin area after treatment,and the temperature difference from the corresponding healthy side becomes smaller.