Comparative Efficacy of Short-Term Spinal Cord Stimulation for Subacute Zoster-Associated Pain: A Three-Group Propensity Score-Matched Analysis

INTRODUCTION: Spinal cord stimulation (SCS) has emerged as a promising modality for managing zoster-associated pain (ZAP). This study aimed to evaluate the efficacy and safety of short-term spinal cord stimulation (SCS) for treating ZAP during the subacute phase. METHODS: Records of patients undergoing transforaminal epidural injection (TFEI), pulsed radiofrequency (PRF), and short-term SCS were retrospectively reviewed. A 1:2:2 propensity-score matching was performed. The primary endpoint was Numeric Rating Scale (NRS) pain scores at 3 months after rash onset. Secondary endpoints included postherpetic neuralgia (PHN) incidence, Hospital Anxiety and Depression (HADS) scores, Pittsburgh Sleep Quality Index (PSQI) scores, quality-adjusted life years (QALY) scores, and adverse events. RESULTS: At 3 months post-rash onset, mean NRS pain score was 1.59 ± 1.18 in SCS cohort, which was lower than that of 4.80 ± 1.41 in TFEI cohort and 4.54 ± 1.40 in PRF cohort, with the difference exceeding the prespecified minimal clinically important difference of three points (p < 0.001). PHN occurred in 8.9% of patients in SCS cohort at 3 months and 5.9% at 6 months following rash episode, which was lower than the other two cohorts (both p < 0.001). The proportion of patients requesting weak opioids for rescue pain relief was lower in SCS cohort, with less usages, at these time points. SCS cohort had better improvements in terms of HADS, PSQI and QALY scores over time compared to both TFEI and PRF cohorts (all p < 0.05). No severe adverse events were observed. CONCLUSIONS: Among patients with subacute ZAP, short-term SCS was more effective than TFEI or PRF, resulting in greater improvements in PHN occurrence, psychological function, sleep quality, and quality of life.