Combined Pulsed Radiofrequency and Epidural Steroids for Herpes Zoster Pain: Efficacy and Safety

Evaluation of the Efficacy and Safety of Combined Pulsed Radiofrequency and Epidural Steroid Injection in Herpes Zoster-Related Pain.

In this study, we aimed to evaluate the effectiveness of Pulsed Radiofrequency (PRF) and Transforaminal anterior epidural steroid injection (TFAESI) applied to the dorsal root ganglion (DRG) in herpes zoster pain.

The results of patients who underwent DRG PRF and TFAESI for herpes zoster-related pain in the Algology clinic between June 2026 and March 2023 were evaluated retrospectively. Demographic and clinical examination findings (gender, age, involved dermatome, side, neurologic examination, medications used) and VAS scores were recorded. VAS pain scores and complication findings were recorded at 1 month, 6 months and 12 months after the procedure.

Datas of 93 patients were evaluated. 66 patients were in acute/subacute pain while 27 patients had postherpetic neuralgia (PHN) at presentation. 11 patients had cervical, 75 patients had thoracic segment involvement, and 7 patients had lumbar segment involvement. Cervical, thoracic and lumbar DRG and TFAESI were performed according to the segment involved. VAS scores for all three regions were significantly lower than pre-procedure at 1 month, 6 months and 12 months after the procedure (p<0.001, p<0.001nvolved DRG, p=0.008, respectively). There was no significant difference for PHN at 6 months and 12 months follow-up (p=0.3, p=0.6). While 2 patients developed nausea and dizziness due to subdural and intravenous leakage after the procedure, no fatal complications were recorded in any patient.

In herpes zoster-associated refractory neuropathic pain, fluoroscopy-guided combined DRG and TFEASI application methods provide long-term effective pain control and are safe both in the acute/subacute phase and in patients who develop PHN.