Objective: To analyze the efficacy and safety of pulsed radiofrequency (PRF) for the treatment of thoracic postherpetic neuralgia (PHN) in elderly patients with different pain phenotypes. Methods: A total of 201 elderly thoracic PHN patients, including 110 males and 91 females aged (72.2±6.9) years who received high-voltage, long-duration PRF at the dorsal root ganglion at Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine from January 2020 to December 2022, were retrospectively included. The neuropathic pain symptom inventory (NPSI) was used to evaluate the five different pain phenotypes, which included superficial spontaneous pain, deep spontaneous pain, paroxysmal pain, evoked pain, and paresthesia/dysesthesia, and to analyze the distribution of the five pain phenotypes. The numerical rating scale (NRS) and NPSI scores of all patients were compared before treatment and three months after treatment to evaluate the efficacy and safety of PRF for different pain phenotypes and pain phenotype combinations. Results: All patients had two or more pain phenotypes, and 50.2% (101/201) of the patients had five pain phenotypes at the same time. Compared with those before treatment, three months after treatment, the NPSI scores for superficial spontaneous pain, deep spontaneous pain, paroxysmal pain, evoked pain and paresthesia/dysesthesia decreased (all P<0.05), and the scores decreased by［M（Q1，Q3）］3.0 (2.0, 4.0), 1.5 (0.5, 2.5), 3.0 (2.5, 4.0), 2.3 (1.0, 4.0), and 1.0 (0.5, 2.0) points, respectively, the differences were statistically significant (P<0.001). The decrease in the NPSI score in patients with paroxysmal pain was greater than that in patients with the other 4 pain phenotypes (all P<0.05). After treatment, the NRS score decreased by 4.0 (3.0, 5.0), 4.0 (3.0, 5.0), 4.0 (3.0, 5.0) and 5.0 (4.0, 6.0) points in patients with 2, 3, 4 and 5 pain phenotypes, respectively, and the difference was statistically significant (P<0.001). The decrease in the NRS score was greater in patients with a combination of 5 pain phenotypes than that in patients with a combination of 3 and 4 pain phenotypes (all P<0.05). No complications, such as pneumothorax, haematoma or infection, occurred in any of the patients during treatment. Conclusion: PRF has different therapeutic effects on PHN patients with different pain phenotypes, it has the best effect on paroxysmal pain, and the treatment is safe.
目的： 分析脉冲射频（PRF）对老年胸段带状疱疹后神经痛（PHN）患者不同疼痛表型的疗效及安全性。 方法： 回顾性纳入2020年1月至2022年12月于南京中医药大学鼓楼临床医学院接受背根神经节高电压长时程PRF治疗的老年胸段PHN患者201例，包括男110例，女91例，年龄（72.2±6.9）岁。通过神经病理性疼痛症状问卷（NPSI）评估5种疼痛表型评分，包括表面自发性疼痛、深部自发性疼痛、一过性发作性疼痛、诱发痛、感觉异常/迟钝，分析5种不同疼痛表型的分布情况。比较所有患者治疗前、治疗后3个月疼痛数字评分量表（NRS）评分及NPSI评分，评价PRF对不同疼痛表型及不同疼痛表型组合的治疗效果及安全性。 结果： 所有患者均具有2种及以上疼痛表型，50.2%（101/201）患者同时具有5种疼痛表型。与治疗前相比，治疗后3个月表面自发性疼痛、深部自发性疼痛、一过性发作性疼痛、诱发痛、感觉异常/迟钝NPSI评分均下降（均P<0.05），NPSI评分下降值［M（Q1，Q3）］分别为3.0（2.0，4.0）、1.5（0.5，2.5）、3.0（2.5，4.0）、2.3（1.0，4.0）、1.0（0.5，2.0）分，差异有统计学意义（P<0.001），其中一过性发作性疼痛NPSI评分下降值高于其余4种疼痛表型（均P<0.05）。2、3、4、5种疼痛表型组合患者治疗后NRS评分下降值分别为4.0（3.0，5.0）、4.0（3.0，5.0）、4.0（3.0，5.0）、5.0（4.0，6.0）分，差异有统计学意义（P<0.001）；其中5种疼痛表型组合患者治疗后NRS评分下降值高于3、4种表型组合患者（均P<0.05）。所有患者治疗期间均未发生气胸、血肿、感染等并发症。 结论： PRF对PHN患者不同疼痛表型的治疗效果不同，对一过性发作性疼痛疗效最佳，且该治疗方法安全性较好。.