Clinical outcomes of pharmacologic versus non-pharmacologic interventions in postherpetic neuralgia: A retrospective cohort study

This study evaluates the comparative effectiveness and safety of pharmacologic and non-pharmacologic therapies in managing postherpetic neuralgia (PHN), aiming to refine clinical pain management approaches. A retrospective analysis was conducted on 60 patients diagnosed with PHN and treated between June 2022 and June 2024. Based on differences in prior treatment approaches, patients were matched and allocated into pharmacologic (n = 30) and non-pharmacologic (n = 30) treatment groups using propensity score matching to reduce baseline confounding. All participants were followed for 24 months. Primary endpoints included pain intensity (assessed via the visual analogue scale, VAS), health-related quality of life (measured by the SF-36 questionnaire), and sleep quality (evaluated using the Pittsburgh sleep quality index, PSQI). Adverse events were systematically recorded throughout the follow-up period. Both groups demonstrated statistically significant improvements in VAS, SF-36, and PSQI scores from baseline (P < .05). The pharmacologic group exhibited superior pain reduction at 12 months (mean VAS 4.5 ± 1.2 vs 5.0 ± 1.5; P < .05) and greater quality-of-life enhancement (SF-36 60.2 ± 7.9 vs 57.4 ± 8.4; P < .05). Sleep quality improvements favored pharmacologic therapy at 3 months (PSQI 12.0 ± 3.4 vs 13.4 ± 3.6; P < .05), though this difference attenuated by 12 months (P > .05). Adverse events were mild: pharmacologic interventions were associated with higher rates of dizziness (16.7%) and somnolence (10.0%), whereas non-pharmacologic methods primarily caused localized skin reactions (6.7%). Pharmacologic management demonstrated a faster short-term analgesic effect and was associated with improvements in quality of life in this study, while non-pharmacologic approaches appeared to offer potential benefits for long-term supportive care. These findings suggest that a combined therapeutic strategy could be a promising direction for optimizing PHN treatment.