Efficacy and Safety of Pulsed Radiofrequency Combined with Platelet-Rich Plasma in the Treatment of Postherpetic Neuralgia: A Systematic Review and Meta-Analysis

Ziwei Lu,1,2 Chengcheng Zhao,1,2 Huadong Ni,2 Ming Yao2 1Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Anesthesiology and Pain Research Center, The Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, People’s Republic of ChinaCorrespondence: Huadong Ni, Email [email protected] Ming Yao, Email [email protected]: Herpes zoster-associated neuralgia (HZN) is a disease caused by the reactivation of the varicella-zoster virus (VZV) that is latent within the spinal nerves, with a major impact on patients’ quality of life. The objective of this study is to evaluate the efficacy and safety of Pulsed Radiofrequency (PRF) combined with Platelet-Rich Plasma (PRP) in the treatment of HZN, comparing it with PRF alone.Methods: A thorough search was conducted on multiple databases. Several clinical studies from the inception of each database up to December 2024 were included in the study. The primary clinical outcome was the postoperative pain intensity score. Secondary clinical outcomes encompassed sleep quality, the utilization of rescue analgesics postoperatively, and the incidence of adverse events.Results: The final analysis incorporated a total of seven studies, encompassing 568 subjects. With regard to the alleviation of pain, PRF combined with PRP therapy has shown more significant pain relief for HZN when compared with conventional PRF therapy. The combination of PRF and PRP therapy has been demonstrated to be more efficacious in enhancing patients’ sleep quality. With regard to the administration of postoperative rescue analgesics, the dosage of such medication was found to be lower in cases where PRF was combined with PRP therapy. The incidence of adverse events was consistent across both groups.Conclusion: The PRF - PRP is more effective than the traditional radiofrequency pulse therapy in treating HZN. This combination has been demonstrated to enhance sleep quality and reduce the necessity for postoperative rescue analgesics. The potential for this approach extends to its utilization as a novel therapeutic modality for HZN.Keywords: herpes zoster, postherpetic neuralgia, pulsed radiofrequency, platelet-rich plasma