Volume 101 ·  Issue 43 ·  2021

Minimally invasive interventional analgesia technique is one of the core diagnosis and treatment techniques of the pain department. It can diagnose and treat many pain diseases such as chronic musculoskeletal pain, chronic neuropathic pain and chronic cancer pain with less trauma and good effect. With the emergence of new ideas and materials, minimally invasive interventional analgesia will be widely used in the setting of chronic pain diseases, achieve the precise diagnosis and treatment and whole-process management of chronic pain diseases.

Knee osteoarthritis (KOA) is a worldwide disease, and also the main cause of pain and disability in the motor system. Due to the aging population in China, extension of life expectancy and increased number of obese people, the number of people affected by KOA continues to surge. Neither surgical nor non-surgical treatment can change the disease process, but these interventions can reduce pain and disability. The treatment principle of KOA is to start with non-surgical treatment, which has been considered as the first choice for KOA patients due to its advantages of less complications, minimal invasiveness, and low medical cost. This article describes the non-surgical treatment of KOA, aiming to provide new insights into the clinical treatment of KOA.

Platelet-rich plasma is a high-concentration platelet plasma prepared from autologous blood by centrifugation. Its injection therapy can enhance tissue repair and regeneration, and it is increasingly used to treat bone and joint diseases, tendon and fascia injuries, intervertebral discogenic pain and other chronic musculoskeletal pain diseases. In clinical application, the indications and contraindications should be strictly mastered, and the operating methods and procedures should be standardized according to the requirements of different equipment parameters. Pay attention to safety evaluation and prevention of adverse reactions, and perform efficacy follow-up in due course.

Stereotactic biopsy of intracranial lesions is the best way to obtain pathological tissue of intracranial lesions. For intracranial lesions, especially multiple deep and functional area lesions that need clear diagnosis before further treatment (such as radiotherapy, chemotherapy, targeted therapy, etc.), stereotactic biopsy should be the first choice, and the next treatment plan should be formulated on the basis of clear pathology, which has important clinical significance for understanding the mechanism of disease and individualized diagnosis and treatment. This consensus expert group refers to the latest literature at home and abroad, combines with relevant experts engaged in stereotactic intracranial lesion biopsy in the United Nations, combines their respective professional characteristics and experiences, and compiles this consensus around the application of multimodal image fusion technology, indications and contraindications, steps, technical points, intraoperative and postoperative precautions, biopsy techniques of special regional lesions, measures to improve the positive rate of biopsy, and prevention and treatment of intracranial hemorrhage complications, etc., aiming at promoting the standardized development of stereotactic intracranial lesion biopsy in clinical practice in China, and further improving the overall diagnosis and treatment level of difficult neurological diseases in China.

To evaluate the accuracy, efficacy and safety of 3D-printed personalized navigation template in the treatment of thoracic postherpetic neuralgia (PHN) with dorsal root ganglion pulsed radiofrequency (DRG-PRF).

A total of 63 patients with thoracic PHN from March 2019 to December 2020 in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School were enrolled and randomly divided into study group (n=31) and control group (n=32) by random number table method. The study group received DRG-PRF treatment assisted by 3D-printed navigation template, while the control group received DRG-PRF treatment guided by conventional CT. The one-time success rate of puncture, the incidence of puncture times ≥3, the number of punctures, puncture time, visual analogue scale (VAS) score and surgical complications between the two groups were compared.

The one-time success rate of puncture in study group was 84.9% (79/93), which was higher than that of control group [30.2% (29/96)] (P<0.001). The incidence of puncture times ≥3, the number of punctures, puncture time in study group were 4.3% (4/93), 1 (1, 1) and 2.9 (2.8, 3.0) min, respectively, which were lower than that of the control group [21.9% (21/96), 2(1, 3), 9.0 (4.5, 12.9) min, respectively] (all P<0.01). No difference was found in VAS score at each time point before and after surgery between the two groups (all P>0.05). There was one case of pleura puncture in the control group, but no other complications such as straying into vertebral canal, hematoma, spinal cord injury, limb movement disorder, infection were found in the two groups.

3D-printed personalized navigation template is an effective method to guide DRG-PRF for the treatment of thoracic postherpetic neuralgia. It can significantly improve the surgical efficiency of DRG-PRF, but has no significant effect on the surgical efficacy.

To explore the relationship between the anatomic parameters of foramen ovale and intraluminal pressure during percutaneous balloon compression (PBC) in the treatment of primary trigeminal neuralgia.

Twenty patients diagnosed with primary trigeminal neuralgia in the Department of Pain Medicine of the Third Xiangya Hospital, Central South University between November 2020 and April 2021 were enrolled. Three-dimensional (3D) high-resolution CT reconstruction of skull base was performed preoperatively to evaluate the parameters of foramen ovale. The intraluminal balloon pressure was continuously recorded during the PBC procedure. Correlation analysis was conducted between intraluminal pressure and foramen ovale parameters.

Eighteen patients had complete pain relief, 1 had obvious relief, and 1 had partial relief after PBC. The maximum cross-sectional length of the foramen ovale was (7.8±1.7) mm. The peak intraluminal pressure (P_M) during PBC was (194±27) kPa. The intraluminal pressure was (164±28) kPa at initial compression (P₀), and (135±20) kPa after compression for 120 seconds respectively. Correlation analysis showed that the P₀ was positively and significantly correlated with the length of foramen ovale (r=0.56, P<0.05), but not with the width of foramen ovale (r=0.24, P>0.05), the area of foramen ovale (r=0.36, P>0.05) and the degree of balloon filling (r=-0.09, P>0.05). Similarly, P₁₂₀ was significantly correlated with the length of foramen ovale (r=0.54, P<0.05). No significant correlation was observed between P₁₂₀ and the width of the foramen ovale (r=0.18, P>0.05), the area of the foramen ovale (r=0.28, P>0.05) or the width of balloon filling (r=-0.13, P>0.05).

The length of foramen ovale correlates with the intraluminal pressure during PBC procedure in trigeminal neuralgia patients. Parameters of foramen ovale obtained via preoperative high-resolution CT reconstruction of skull base may provide reference for predicting targeted intraluminal balloon pressure during PBC.

To investigate the effects of different doses of glucocorticoids on minimally invasive procedures in patients with type 2 diabetes mellitus (T2DM), and optimize the clinical pathways of minimally invasive procedures.

The clinical data of 284 patients with T2DM who received minially invasive procedures from the Department of Pain Medicine, West China Hospital, Sichuan University from May 2017 to May 2020 were retrospectively reviewed. The patients were divided into two groups according to the main diagnostic types: spine-related group (n=148) and herpes zoster group (n=136). According to the cumulative dose of glucocorticoids (GCs) per unit body surface area during the hospitalization, patients were further divided into three subgroups: low-dose group (GCs<3.5 mg/m²), medium-dose group (3.5 mg/m² ≤GCs<7 mg/m²), and high-dose group (GCs≥7 mg/m²). The clinical characteristics of the patients in different subgroups of the two diseases groups were compared. The effects of the glucocorticoids on the pain intensity, blood glucose, length of hospital stay (LOS) and total hospitalization cost were compared among the 3 subgroups of the two diseases groups.

There were no significant differences in the age, gender, height, weight, visual analog scale (VAS) and fasting blood glucose before procedures between the two groups (all P>0.05). The VAS score of the low-dose group from the spine-related group was 4.5±1.6, which was higher than that of the medium-dose group (3.5±1.3) (P=0.004). VAS score was 4.3±1.3 in the medium-dose group and 4.4±1.6 in the high-dose group from the herpes zoster group, which were higher than that in the low-dose group (3.5±0.9) (P=0.006). In terms of blood glucose, the impact on the fasting blood glucose before and after the procedures in the low-dose group from the spine-related group was less than that in the medium dose group (P=0.013). In the herpes zoster group, the blood glucose of the low-dose group was (11±5) mmol/L, which had less influence on the blood glucose fluctuation during the hospitalization than that in the high-dose group [(15±5) mmol/L] (P<0.05). The LOS and hospitalization cost in the low-dose group from the spine-related group were (9±4) d and (10 583±4 851) yuan, respectively, which were less than those in the medium-dose group [(11±3) d and (15 202±7 418) yuan] and high-dose group [(13±6) d and (18 100±4 138) yuan] (allP<0.05); however, there was no significant difference among different subgroups in the herpes zoster group (allP>0.05).

When used in the patients with T2DM undergoing minimally invasive procedures for spine-related diseases, low-dose glucocorticoids can obtain more clinical benefit than high dose, and high dose can lead to raised blood glucose, prolong the LOS, and increase the hospitalization cost.

To observe the clinical efficacy of spinal cord stimulation (SCS) in the treatment of diabetic foot (DF).

Sixteen patients who were diagnosed with DF and treated with SCS from the Department of Pain Medicine of the First Affiliated Hospital, China Medical University from October 2015 to October 2018 were retrospectively analyzed. Visual analogue scale (VAS), 36-item short form health survey (SF-36), transcutaneous oxygen partial pressure (TcPO₂) and skin temperature of lower limbs were compared before and after treatment, and the complications were recorded.

Among the 16 patients, 14 were equipped with implantable pulse generator (IPG). The VAS scores decreased significantly from 7.5±1.2 before treatment to 2.6±0.8, 2.0±0.7, 1.6±0.6, 1.0±0.9, 0.9±0.9 at 1 day, 1 week, 3 months, 6 months and 12 months after electrode implantation respectively (all P<0.05). At 12 months after treatment, the parameters of SF-36 were significantly different from those before treatment (all P<0.05). The TcPO₂ was (23±5) mmHg before treatment and (38±6) mmHg at 1 week after treatment, with a statistical difference (P<0.05), and the temperature of lower limbs increased significantly (P<0.05). No serious complications were observed in all patients.

SCS can relieve the pain of patients with DF, improve the microcirculation and blood supply of lower limbs, and thus promote the quality of life, with rare serious complications.

To explore the efficacy of radial shock wave therapy (RSWT) for lateral epicondylitis (LE).

A total of 54 cases suffering from LE from Department of Pain Medicine of Fujian Provincial Hospital between December 2017 to October 2019 were randomly assigned to experimental group (n=27) and control group (n=27). Subjects in the experimental group were applied with RSWT in the lateral elbow area plus scapular back area, while patients in control group were applied with RSWT only in the lateral elbow area. Patients in both groups underwent RSWT one session per week for four weeks. Numeric rating scale (NRS), pain-free grip (PFG) test and patient-rated tennis elbow evaluation (PRTEE) in both groups were evaluated and compared at the pre-treatment, one week, one month and three months after treatment.

The NRS scores at pre-treatment, one week, one month and three months after treatment in experimental group were 6.5±1.6, 4.0±1.1, 3.9±1.5, 1.7±1.1, respectively, while those in control group were 6.2±1.4, 3.8±1.3, 4.2±1.2, 2.6±1.2, respectively. Compared with those at pre-treatment, the NRS scores in both groups were significantly decreased at one week, one month and three months after treatment (all P<0.05). The PRTEE and PFG results showed significant improvement after treatment (allP<0.05). The NRS scores and PRTEE at three months after treatment in the experimental group were 18±11, 1.7±1.1, respectively, which were significantly lower than those in the control group (25±11, 2.6±1.2, respectively) (bothP<0.05).

RSWT exerts a beneficial effect on LE. Guided by the soft tissue surgery theory, RSWT in the lateral elbow area plus scapular back area produces better pain reduction and functional improvement compared with RSWT only in the lateral elbow area.

To explore the efficacy and safety of high-voltage long-duration pulsed radiofrequency (PRF) treatment in patients with neuralgia resulting from failed back surgery syndrome (FBSS).

The clinical data of 58 patients diagnosed with neuralgia resulting from FBSS in the Department of Pain Medicine, Peking University Third Hospital from January 2017 to January 2020 were retrospectively analyzed. The patients were divided into two groups according to the treatment method. Experimental group (n=28) underwent high-voltage long-duration PRF therapy, using ultrasound and X-ray guidance to target the spinal nerve of the affected side, while control group (n=30) was applied with the standard pulsed radiofrequency therapy. Visual analogue scale (VAS), Oswestry disability index (ODI), 36-item short form health survey (SF-36), patient health questionnaire (PHQ-9) before treatment and at 1 week, 1 month, and 6 months after treatment were recorded. Meanwhile, postprocedural complications and adverse reactions were also collected.

VAS, ODI, SF-36 and PHQ-9 scores at 1 week, 1 month, and 6 months after treatment were significantly improved in both groups compared with their respective pre-treatment baseline scores (all P<0.01). The differences of VAS, ODI, and PHQ-9 scores between the two groups were not statistically significant at 1 month after treatment (allP>0.05). However, VAS, ODI, and PHQ-9 scores were lower in experiment group than those in control group at 6 months after treatment (allP<0.05). The marked improvement rate and total effective rate at 6 months after treatment in experiment group was 78.6% (22/28) and 92.9% (26/28), respectively, which were higher than that of control group [60.0% (18/30) and 83.3% (25/30), respectively], but the differences were not statistically significant (bothP>0.05). No serious complications occurred during the whole period of treatment.

Both treatments can effectively relieve the lower limb neuralgia. High-voltage long-term PRF has better efficacy and longer duration than standard PRF.

To investigate the analgesic efficacy and safety of state-dependent sodium channel blocker-bulleyaconitine combined with calcium channel blocker-gabapentin on postherpetic neuralgia (PHN).

A double-blind, randomized, placebo-controlled, parallel-group, multi-center study involving Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Qinghai Provincial People′s Hospital, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, the Second Affiliated Hospital of Kunming Medical University was performed from September 2018 to December 2019. A total of 75 PHN patients were randomly divided into the experiment group (n=41) and the control group (n=34). On the basis of first-line treatment with gabapentin, the experiment group was given bulleyaconitine A tablets, while the control group was given placebo. The primary outcome was a 50% improvement in the visual analogue scale (VAS), and the effective rate of achieving the primary outcome between the two groups was compared; the Cox regression model was used to analyze the impact of related factors on the disease outcome. Secondary outcomes including scores of pain scales (ID-pain, DN4), Patient Health Questionnaire (PHQ-9), 7-item Generalized Anxiety Disorder (GAD-7) at 1, 2, 3, 4, 8, 12 weeks after treatment were applied to evaluate the efficacy and safety of the combination of bulleyaconitine A tablets with first-line drug in the treatment of PHN.

The effective rate was 68.3% (28/41) and the time reached the primary outcome was 28 (7, 84) days in the experiment group, while in the control group, the effective rate was 52.9% (18/34) and the time reached the primary outcome was 56 (14, 84) days. Cox regression analysis indicated that the grouping factor of oral bulleyaconitine A tablets was an independent factor for improving the outcome of PHN (HR=2.063, 95%CI: 1.059-4.018, P<0.05), and the probability of the experiment group reaching the primary outcome was 2.063 times that of the control group (P<0.05). Meanwhile, the outcome probability of the long disease course group (>6 months) was only 0.201 times that of the short disease course group (<6 months) (HR=0.201, 95%CI: 0.073-0.551, P<0.05). There was no statistically significant difference in the trend of VAS between the two groups (P>0.05). The scores of ID-pain, DN4, PHQ-9, and GAD-7 of the two groups were significantly improved compared with those before enrollment (P<0.05), but the differences between the two groups were not statistically significant (allP>0.05).

Bulleyaconitine A tablet can promote the therapeutic efficacy of gabapentin, and improve the outcome of PHN in a short period of 3 months.

To investigate the molecular mechanism of oxaliplatin-induced chemotherapy-induced peripheral neuropathic pain (CIPNP).

A total of 16 male Sprague-Dawley rats of specific pathogen-free grade were randomly divided into two groups: oxaliplatin experimental group (2.4 mg/kg oxaliplatin dissolved in 5.0% glucose solution, n=8) and control group (equal volume 5% glucose solution, n=8). The rat model of CIPNP was established by continuous administration with oxaliplatin. In addition, mechanical allodynia, thermal hyperalgesia and cold hyperalgesia were measured and compared between the two groups. To explore the molecular mechanism of oxaliplatin-induced CIPNP, the gene expression of dorsal root ganglia (DRG) from the rat model of CIPNP was analyzed using RNA sequencing (RNA-Seq).

Mechanical and thermal hypersensitivity was exhibited on day 7 and a stronger hypersensitivity was observed on day 14. A total of 20 152 genes were quantified by RNA-Seq, and 379 differentially expressed genes (DEGs) were obtained with absolute fold change cut-offs ≥ 2 and P value<0.05. There were 7 genes (Npy, Car3, Cdkn1a, Nts, Prc1, Ms4a7 and Ecel1) that were involved in peripheral nerve injury-related neuropathic pain. Gene ontology (GO) functional enrichment analyses indicated that the DEGs induced by oxaliplatin were involved in oxygen transport, cell division, intermediate, centromere, oxygen transporter activity, oxygen binding. Moreover, the result of Kyoto Encyclopedia of genes and genomes (KEGG) analyses highlighted that the DEGs induced by oxaliplatin were involved in malaria, African trypanosomiasis, primary immunodeficiency, peroxisome proliferator activated receptor (PPAR) signaling pathway.

Oxaliplatin induces CIPNP via pain-related genes and signaling pathways.

To identify the influencing factors of thrombosis besides antiphospholipid antibodies in patients with antiphospholipid syndrome (APS).

The 169 patients diagnosed with APS were enrolled according to the current APS classification criteria from January 2003 to August 2017 in Peking University People′s Hospital. There were 23 males and 146 females with a mean age of (41±15) years. Antiphospholipid antibodies, including anticardiolipin (aCL), anti-β2glycoprotein-1 (β2GP1) antibodies and antibodies to the phosphatidylserine-prothrombin complex (aPS/PT), were determined by enzyme-linked immunosorbent assay (ELISA) methods. Lupus anticoagulant (LA) was identified using the STA Compact coagulation testing system. The differences of clinical and laboratory characteristics between patients with and without thrombosis were analyzed (100 cases and 69 cases, respectively). The influencing factors for thrombosis in patients with APS were determined using binary logistic regression.

Compared with patients without thrombosis, patients with thrombosis were older and had a longer disease duration ((45±17) years vs (35±9) years and M(Q₁, Q₃) 12.0(3.8, 84.0) months vs 48.0(12.0, 108.0) months, both P<0.05). The percentage of male, primary APS, smoking, low blood platelet count, hypertension, and diabetes in patients with thrombosis were significantly higher than those in patients without thrombosis (allP<0.05). Similarly, the rates of antinuclear antibodies positive, aCL positive, aPS/PT-IgM positive, and aPS/PT-IgG positive in patients with thrombosis were significantly higher than those in patients without thrombosis (allP<0.05). The levels of D-dimer in patients with thrombosis were significantly higher than that in patients without thrombosis (P<0.05). There was significant difference in global anti-phospholipid syndrome score (GAPSS) between patients with and without thrombosis (P<0.05). The GAPSS score was also significantly higher in patients with arterial thrombosis than that in patients with venous thrombosis (P<0.05). Smoking and D-dimer levels were independent influencing factors for thrombosis in patients with APS (smoking:OR=11.222, 95%CI:1.119-112.544, P=0.040, D-dimer levels: OR=1.002, 95%CI: 1.000-1.003, P=0.037).

Thrombotic APS patients are older and have a longer suffering duration, a higher ratio of male, primary APS, smoking, hypertension, lower blood platelet count, diabetes, higher GAPSS scale, and higher D-dimer levels. Smoking and D-Dimer levels may be independent risk factors for thrombosis in patients with APS.

To analyze the correlation between the parameters of diffusion tensor imaging (DTI) and the clinical function scores before and 5 years after anterior cervical discectomy and fusion (ACDF) by measuring the DTI signal of the maximum compression level (MCL) of the cervical spinal cord in patients with cervical spondylotic myelopathy (CSM).

A prospective study was conducted and clinical data of 37 patients with CSM treated by ACDF in Beijing Chaoyang Hospital from February 2014 to February 2020 were analyzed. The MCL was studied with diffusion tensor imaging (DTI) of MRI. The changes of diffusion indexes (fractional anisotropy (FA)), and clinical function score including Modified Japanese Orthopedic Association (mJOA), neck disability index (NDI) and visual analog scale (VAS) of pain were compared among each follow-up point. The FA value and clinical function score were collected and the data was analyzed to determine whether the high signal intensity could be observed in T₂-weighted imaging (T₂WI) at each follow-up point. The changes of preoperative and postoperative data were compared, and the correlation between FA value and other two clinical function score were analyzed at each follow-up point.

There were 14 males and 23 females with a mean age of (55±10) years in this study. All patients received the surgery and the medullary symptoms improved significantly postoperatively. After 3 months, the mJOA and FA value were improved by 2.62±1.41 and 0.14±0.11 on average, respectively (both P<0.05); and there were significant differences in these two indexes between each follow-up point in two years after the operation (allP<0.05). At the MCL, there were strong correlations between the FA value and mJOA score pre-and postoperatively (r_s=0.770, 0.729, both P<0.01). There was no significant correlation between mJOA, NDI and VAS (bothP>0.05).

The DTI sensitively reflects the improvement of spinal cord function and can be used as an important tool to predict and evaluate the state of spinal cord dysfunction in patients with CSM.

The data of clinical characteristics, medical cost and prognosis of 22 anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis children from the Department of Neurology, Capital Institute of Pediatrics between May 2018 and January 2021 were analyzed, and 6 of them occurred paroxysmal sympathetic hyperactivity syndrome (PSH). It was found that the anti-NMDAR encephalitis children with PSH had severer consciousness disorder [median Glasgow Coma Scale (GCS) score at admission: 7.5], longer duration of consciousness disorder (median time: 53 days), higher hospitalization cost (median cost: 230 000 RMB), severer neurological injury at onset [median modified Rankin Scale (mRS) score at admission: 4], and longer recovery time of neurological function (median time of mRS score recovered to 0-2: 7 months), compared with those without PSH (allP<0.05). Therefore, more attention should be paid to sympathetic excited symptoms of anti NMDAR encephalitis, and thus identify and intervene early on PSH to reduce the neurological damage and economic burden.

Moderate to severe cancer pain seriously affects the quality of life of patients. In recent years, the safety and effectiveness of intrathecal drug infusion technology have attracted much attention, and the application scope in patients with cancer pain has been continuously expanded. This paper summarizes the clinical application progress of intrathecal drug infusion technology from the aspects of implantation timing, potency ratio, intrathecal drug selection, etc. At the same time, the research and development of intrathecal drugs and devices are prospected.

Treatment-refractory depression (TRD) is a common clinical disease state. It usually refers to depression that has not been relieved (usually refers to Hamilton Depression Scale-17 items ≤7 points) after sufficient doses and courses of treatment with two or more antidepressants with different mechanisms of action. Scientific grading and assessment of TRD is the basis for timely treatment. At present, there are four models for the grading assessment of TRD. Among them, the Massachusetts General Hospital Grading Model, which uses the Massachusetts General Hospital Antidepressant Treatment Questionnaire (MGH-ATRQ) to evaluate patients, is widely used internationally. Combining the advantages and disadvantages of the four existing TRD grading models, this paper proposes a new prospect for TRD grading and evaluation.

Hydromorphone can replace morphine in the treatment of refractory cancer pain by intrathecal drug infusion system (IDDS), however, there is not sufficient clinical evidence to prove it. This study included 233 patients from 12 pain management centers in China who were randomized into two groups: intrathecal hydromorphone infusion group (ITHM,n=121) and the intrathecal morphine infusion group (ITMO,n=112）。 The primary outcome measure was clinical success, defined as the rate of ≥50% pain relief in patients. The non-inferiority margin (NIm) was 15%. Secondary outcome measures included daily visual analog scale of pain (VAS), incidence of burst pain (BTP), intrathecal drug dose, number of patient intravenous controlled analgesia (PCA) compressions, and anxiety and depression status (Patient Health Questionnaire Depression Scale PHQ-9, Generalized Anxiety Scale GAD-7). Clinical success was achieved in 85 (70.2%) and 79 (70.5%) of 121 patients with ITHM and 112 patients with ITMO, respectively. Patients in both groups had significant decreases in VAS scores and BTP incidence compared to the corresponding baseline. From Week 3 onwards, the rate of dose change decreased over time in the ITHM and ITMO groups (-3.33% vs. 35.4%,P<0.01）。 From week 1 onwards, the rate of change in the number of PCA compressions was lower in the ITHM group than in the ITMO group (-19.88% vs. 7.79%,P<0.01）。

Herpes zoster (HZ) is characterized by a vesicular rash accompanied by pain and mainly affects the elderly and immunocompromised people. The epidemiological data of HZ in China suggest that the relevant data of people over 50 years old who have not received HZ vaccine in China are still insufficient. This study aimed to evaluate the epidemiological characteristics, disease burden and associated risk factors of HZ in people aged ≥50 years in our country.

Postherpetic neuralgia (PHN) is a chronic pain caused by varicella zoster virus infection and is common in older adults. The typical clinical sign of PHN is a persistent tingling or burning pain with spontaneous pain that severely affects the quality of life of elderly patients. Its pathogenesis is complex and its treatment is difficult. Pulsed radio frequency (PRF) is a minimally invasive technique for applying a pulsed current to a target nerve. Recent studies have confirmed the beneficial effects of PRF on postoperative pain, peripheral neuropathological pain, and postherpetic neuralgia. The thoracic nerve (T1-12) is the most common site of PHN involvement, with an incidence of up to 50%. Studies have shown that both dorsal root ganglion (DRG) and intercostal nerve (ICN) in combination with PRF are effective in the treatment of thoracic postherpetic neuralgia. However, there have been no studies comparing the analgesic effects of these two methods in elderly patients. The purpose of this study was to evaluate the efficacy and safety of ultrasound-guided DRG or ICN for PRF modulation in the treatment of elderly PHN, and to provide theoretical basis for clinical treatment. Elderly patients were divided into two groups according to needle position: DRG group and ICN group. Visual analog scale (VAS) and brief health status questionnaire (SF-36) were used to assess the pain intensity and quality of life of patients before treatment and 2, 4, and 12 weeks after treatment, and the occurrence of adverse reactions during treatment was recorded.