Minimally Invasive Interventional Therapy in the Standardization and Individualization of Postherpetic Neuralgia Management

Minimally invasive interventional therapy for postherpetic neuralgia (PHN) faces a critical challenge in balancing standardized protocols with individualized patient needs. Current limitations include insufficient evidence-based guidance for optimal technique selection (e.g., pulsed radiofrequency [PRF] parameters, nerve blockade timing, spinal cord stimulation [SCS] modes) and over-reliance on simplified approaches like routine epidural blockade, neglecting potential synergies of multimodal strategies. Significant heterogeneity exists regarding PRF efficacy (high-voltage vs. standard, influenced by comorbidities like diabetes) and the optimal intervention window for nerve blockade (acute vs. subacute phase). While novel SCS modalities (high-frequency, burst, DRG stimulation) offer promise, especially for allodynia, robust validation is lacking. Furthermore, standardized protocols inadequately address individual anatomical variations (e.g., ganglion morphology) and physiological factors (e.g., reduced thermal tolerance in diabetes), compounded by guideline gaps in stage-specific (acute inflammatory vs. chronic remodeling) and parameter-specific recommendations. To reconcile standardization with individualization, a stratified treatment pathway ("pharmacotherapy →minimally invasive interventional techniques→combined therapy") tailored to pain intensity, duration, and comorbidities is proposed: SCS is recommended first-line for severe cases with significant comorbidities or extensive lesions, while PRF combined with epidural blockade may suit others. Integrating machine learning to analyze patient data and procedural parameters for complication risk prediction offers a pathway towards optimized efficacy and safety. Urgent guideline refinements incorporating stratified recommendations, parameter rationales, and individual variability are essential for advancing precise PHN management.