Pulsed Radiofrequency Alone Versus Combined With Stellate Ganglion Block for Acute Herpes Zoster–Associated Trigeminal Neuralgia in Patients With Pain Catastrophizing: A Retrospective Cohort Analysis

Abstract

Purpose This study compared the efficacy of pulsed radiofrequency (PRF) combined with stellate ganglion block (SGB) versus PRF alone in managing acute herpes zoster–associated trigeminal neuralgia (HZTN) with pain catastrophizing. Patients and Methods Between 2019 and 2024, 61 patients were divided into two groups: the PRF group (supraorbital nerve PRF, n = 31) and the PRF + SGB group (PRF combined with SGB, n = 30). Pain (VAS), sleep quality (PSQI), and pain catastrophizing (PCS) were evaluated at baseline, at 1 and 2 weeks, and at 1, 3, and 6 months post‐treatment. Adverse events and satisfaction were also tracked. Results The PRF + SGB group showed better pain relief and sleep improvement within the first 3 months (p < 0.05) but not at 6 months. Both groups improved in PCS scores (p < 0.05), but PRF + SGB had consistently lower scores at all follow‐ups (p < 0.05). Multivariable regression showed that the treatment group was independently associated with 6‐month PCS, but not with 6‐month VAS or PSQI. Patient satisfaction was higher in the PRF + SGB group (p < 0.05). No significant adverse events occurred in either group. Conclusion Combining PRF with SGB was associated with greater short‐term efficacy in reducing pain, improving sleep, and relieving pain catastrophizing, with higher patient satisfaction and a favorable safety profile. However, the benefits in pain and sleep were not sustained at 6 months, suggesting mainly early clinical benefit and a persistent association with improved pain catastrophizing.