Impact of Pulsed Radiotherapy on Pain and Quality of Life in Elderly Postherpetic Neuralgia Patients

Introduction

Postherpetic neuralgia (PHN) is a clinical syndrome characterized by chronic neuropathic pain persisting for more than 1 month after the healing of a herpes zoster rash. The typical manifestations of PHN include persistent burning pain and paroxysmal stabbing or sharp pain, often accompanied by sensory abnormalities such as allodynia and hyperalgesia. These symptoms persist long after the complete resolution of skin lesions [1]. PHN not only leads to physical dysfunction but also significantly reduces patients’ quality of life and is frequently associated with psychiatric comorbidities such as anxiety and depression [2]. In recent years, pulsed radiofrequency (PRF), as a neuromodulation technique, has been shown to alleviate neuronal edema, mitochondrial swelling, and endoplasmic reticulum structural abnormalities through pulsed electrical currents. It reduces central sensitization while activating the brainstem descending pain inhibitory system, thereby exerting analgesic effects [3]. Due to its advantages, such as minimal risk of thermal nerve damage, low complication rates, and repeatability [4], PRF has become an important therapeutic approach for chronic neck pain [5], trigeminal neuralgia [6], and PHN [7]. It has been reported that the people over 60 years old have a significantly increased risk of PHN occurrence, with an incidence rate of 50–70% [8,9], primarily due to the gradual decline of immune function with aging. In clinical nursing practice, pain management interventions for PHN patients (including multidimensional pain management, psychological support, and lifestyle guidance) have been frequently reported to improve treatment response rates and pain control satisfaction [10,11]. However, their effects on overall quality of life remain limited. Therefore, this study evaluated pain management using PRF in 74 elderly patients with PHN. We anticipate that this research will help alleviate patients’ pain intensity, improve their anxiety and depression status, and enhance their satisfaction with pain control, thereby providing more effective intervention strategies for clinical practice.

Material and Methods

GENERAL INFORMATION:

This study retrospectively enrolled 74 elderly patients with PHN who were treated at our hospital between February 2024 and May 2024. Based on perioperative pain management protocols, patients receiving conventional perioperative care were assigned to the control group (n=37), while those undergoing structured perioperative pain management were allocated to the observation group (n=37).

Inclusion criteria: (1) Diagnosis of PHN according to the International Association for the Study of Pain (IASP) diagnostic criteria [12]; (2) Age ≥65 years; (3) Lesions involving the T1–T12 spinal nerve dermatomes; (4) Visual Analog Scale (VAS) score ≥6, with pain significantly affecting daily activities and sleep quality; (5) Complete and retrievable clinical records. Exclusion criteria: (1) Comorbid malignancies, active tuberculosis (including pulmonary or bone tuberculosis), or other severe systemic diseases; (2) Coagulation disorders; (3) Autoimmune diseases (eg, rheumatoid arthritis, systemic lupus erythematosus); (4) Severe infectious diseases such as HIV or syphilis; (5) Use of antidepressant/anxiolytic medications during the study period; (6) History of chronic alcoholism. The study protocol was reviewed and approved by the Institutional Ethics Committee of our hospital (No. 2024-545), and written informed consent was obtained from all participants.

CONVENTIONAL PHARMACOLOGICAL THERAPY:

Upon admission, all patients initially received conventional pharmacotherapy. On days 1–2, they were administered 75 mg pregabalin (Chongqing Sailwei Pharmaceutical Co., Ltd., National Medicine Approval No. H20130073) orally twice daily, with the dosage adjusted to 150 mg twice daily from day 3 onward. Additionally, 12.5 mg amitriptyline hydrochloride (Changzhou Siyao Pharmaceutical Co., Ltd., National Medicine Approval No. H32020455) was administered orally once daily at bedtime, and 500 μg mecobalamin (Ningxia Jinwei Pharmaceutical Co., Ltd., National Medicine Approval No. H20084594) was administered orally 3 times daily. All patients underwent a 3-month pharmacotherapy course, with individualized dosage adjustments based on pain relief and drug tolerance. Subsequently, all patients received pulsed radiofrequency (PRF) treatment under CT guidance. During the procedure, the puncture needle position was adjusted in real-time under CT monitoring to ensure precise placement of the needle tip at the posterior third of the intervertebral foramen. After confirming the absence of blood or cerebrospinal fluid via aspiration, 1 mL of contrast agent was injected to verify the accuracy of the puncture position and rule out pleural injury. Upon successful confirmation, 0.5 mL of 2% lidocaine was administered locally for infiltration anesthesia. PRF treatment was then performed using a radiofrequency pain therapy device (Model: XJ-03, Shandong Chuanyi Medical Equipment Co., Ltd.) with the following parameters: pulse width of 20 ms, frequency of 2 Hz, and a single treatment cycle duration of 900 s. Patients were closely monitored for 24 hours after treatment.

TREATMENT PROTOCOL FOR CONTROL GROUP:

In addition to conventional drug therapy, patients in the control group received a standard perioperative nursing protocol, which included the following components: (1) Treatment-related health education: Verbal explanations were provided to introduce the principles of pulsed radiofrequency therapy, its clinical significance, and relevant disease knowledge. (2) Basic daily care: The ward’s temperature, humidity, and lighting were regulated, and warmth-preserving measures were implemented. All nursing procedures were scheduled outside the patients’ rest periods. Bedding was regularly changed and disinfected, and patients were advised to wear loose cotton clothing to maintain skin cleanliness and prevent scratching-induced infections. Antiviral ointments were applied as prescribed to treat scabs. (3) Environmental management: Regular ventilation and disinfection of the ward were performed. (4) Treatment supervision: Medication adherence and disease progression were monitored.

TREATMENT PROTOCOL FOR OBSERVATION GROUP:

The observation group received a comprehensive perioperative pain-psychological intervention protocol in addition to the standard care provided to the control group. (1) Pain Management Protocol. This study adopted a multimodal intervention strategy. First, the visual analog scale (VAS) was used to assess patients’ pain levels, and pain education was tailored to individual cognitive levels to ensure accurate expression of pain perception. The pain interventions included: 1) Pharmacological Analgesia: Analgesic medications were administered in accordance with the principle of stepwise drug delivery. 2) Non-Pharmacological Interventions: Attention-diversion techniques and Traditional Chinese Medicine (TCM) acupoint application therapy were implemented. 3) Acupoint Application Therapy: The main acupoints selected were Shenmen (HT7), Zhaohai (KI6), and Anmian (Extra), with Neiguan (PC6) and Sanyinjiao (SP6) as supplementary points. Before the procedure, the skin was disinfected with 75% ethanol. A medicinal paste was prepared by mixing Rhizoma Corydalis (Yanhusuo), Kansui Root (Gansui), Ephedra (Mahuang), and Asarum (Xixin) in a 1: 1: 1: 2 ratio with fresh ginger juice, forming 1-cm diameter cakes. These were applied for 2 hours to achieve analgesic effects. Additionally, a paste made from cinnamon (Rougui), mugwort powder (Aiye), and honey was applied locally to promote sedation. All procedures strictly adhered to aseptic techniques. The medicinal cakes were fixed at the center of adhesive tape, and patients and their families were thoroughly informed about precautions. (2) Psychological Intervention Protocol. A comprehensive psychological support system was implemented for patients through a three-step evaluation-intervention model. First, psychological status assessment was conducted using standardized communication techniques to systematically observe patients’ verbal characteristics, behavioral manifestations, and treatment adherence, with particular focus on evaluating emotional fluctuation patterns, attention concentration levels, and influencing factors, thereby establishing individualized psychological profiles. Second, certified psychological nursing specialists performed emotional counseling interventions, employing active listening techniques to encourage emotional expression and verbal catharsis therapy to facilitate negative emotion release. For highly anxious patients, somatic sensation-focused intervention was implemented within a non-judgmental support environment. Subsequently, during the cognitive behavioral restructuring phase, a multilevel intervention was conducted based on health education theory: 1) Disease cognition was reinforced through multimedia-assisted visual health education, personalized disease explanations involving family members, and a bidirectional Q&A feedback mechanism; 2) Rational emotive therapy was applied to identify irrational beliefs, combined with successful case demonstrations and progressive psychological relaxation training to correct cognitive distortions; 3) Empathy techniques were utilized to validate patients’ emotional experiences, establish a sustained psychological support alliance, and implement a synchronized physiological-psychological intervention plan. All interventions were coordinated with pain management protocols to ensure therapeutic integrity and systematicity.

OBSERVATION INDICATORS:

Assessment of Pain Status. The visual analog scale (VAS) was used to dynamically evaluate pain levels in both groups at 3 time points: before the intervention, 2 weeks, and 4 weeks of intervention. This scale employs a linear scoring system ranging from 0 to 10, where 0 indicates no pain at all, and 10 represents unbearable severe pain that significantly impairs daily activities and sleep quality [13]. The analgesic efficacy of different intervention strategies was objectively assessed by longitudinally comparing the trends in VAS scores between the 2 groups.

Assessment of Psychological Status. The psychological status of patients in both groups was dynamically evaluated using the Hamilton Anxiety Scale (HAMA) and the Hamilton Depression Scale (HAMD). Assessments were conducted at 2 time points: upon hospital admission and after 4 weeks of therapeutic intervention. The scoring criteria for the scales were defined as follows: a score of ≥7 on either scale indicated the presence of significant anxiety or depressive symptoms [14]. The improvement effects of different intervention strategies on psychological status were analyzed by comparing the scores between the 2 groups. A greater reduction in scores indicated a greater intervention effect.

Quality of Life Assessment. Patients’ quality of life (QoL) in both groups was assessed multidimensionally using the 36-Item Short Form Health Survey (SF-36). Evaluations were conducted at 2 time points: upon hospital admission (baseline) and before discharge. The assessment covered 8 domains: role-physical, physiological functions, bodily pain, general health, energy, social function, emotional function, and mental health. The scale employs a standardized scoring system, with each domain scored on a range of 0 to 100. Higher scores indicate better QoL in the respective domain [15]. The study systematically evaluated the effects of different intervention strategies on QoL improvement by comparing the trends in domain-specific scores between the 2 groups.

Assessment of sleep quality. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the improvement in sleep quality between the 2 patient groups. The assessment covered the following 7 components: Subjective sleep quality dimensions, sleep latency, sleep time, sleep efficiency, sleep disorders, daytime dysfunction, and hypnotic drugs. Each component was scored on a 0–3 Likert scale, with the total score ranging from 0 to 21, where a lower score indicated better sleep quality [16]. A total score of ≤5 suggested good sleep quality. The study objectively assessed the effects of different intervention strategies on sleep quality improvement by comparing changes in the total PSQI scores and individual component scores between the 2 groups.

STATISTICAL ANALYSIS:

Data analysis was performed using SPSS 26.0 statistical software. Measurement data were expressed as mean±standard deviation (χ̄±s), and intergroup comparisons were conducted using t-tests. Categorical data were presented as numbers or percentages (n, %) and analyzed using the χ² test. p<0.05 was considered statistically significant.

Results

COMPARISON OF BASELINE CHARACTERISTICS BETWEEN THE 2 GROUPS:

No statistically significant differences were observed in baseline characteristics (including age, gender, and disease duration) between the study group and the control group (P>0.05, Table 1), indicating that the 2 groups were well-matched.

COMPARISON OF VAS SCORES BETWEEN THE 2 GROUPS:

Compared with the pre-intervention scores, the VAS scores of patients significantly decreased after 2 weeks and 4 weeks of intervention (P<0.05, Figure 1, Table 2). Furthermore, the VAS scores at 4 weeks after the intervention were significantly lower than those at 2 weeks (P<0.05, Figure 2, Table 2), with the observation group showing significantly lower scores than the control group (P<0.05, Figure 1, Table 2).

COMPARISON OF HAMA AND HAMD SCORES BETWEEN THE 2 GROUPS:

Compared with the baseline, both groups exhibited a significant reduction in HAMA and HAMD scores after 4 weeks of intervention (P<0.05, Figure 2, Table 3). Moreover, the observation group demonstrated significantly lower scores than the control group (P<0.05, Figure 2, Table 3).

COMPARISON OF SF-36 DIMENSION SCORES BETWEEN THE 2 GROUPS:

Compared with the pre-intervention scores, the SF-36 dimension scores of both groups were significantly increased after 4 weeks of intervention (P<0.05, Figure 3, Table 4), with the observation group showing significantly higher scores than the control group (P<0.05, Figure 3, Table 4).

COMPARISON OF PSQI DIMENSION SCORES BETWEEN THE 2 GROUPS:

After the pain management intervention, the scores for all dimensions of the PSQI in the observation group were significantly lower than those in the control group (P<0.05, Figure 4, Table 5).

Discussion

Elderly PHN is a refractory neuropathic pain syndrome whose pathogenesis is closely associated with neurological damage following varicella-zoster virus infection. Epidemiological data indicate that approximately 30–50% of elderly patients continue to experience pain for over 1 year after herpes resolution, with some cases persisting for up to 10 years [17], making clinical cure particularly challenging. Current therapeutic strategies primarily adopt a multimodal approach combining pharmacotherapy and minimally invasive interventions. Among these, pulsed radiofrequency (PRF) therapy – due to its selective modulation of neural function without structural destruction – synergizes with medications to significantly alleviate pain and improve patients’ quality of life [18]. However, elderly patients commonly exhibit inadequate disease awareness, and PHN is frequently complicated by multidimensional functional impairments, including mood disorders and sleep disturbances [19]. Therefore, when implementing interventional therapies such as PRF, it is imperative to integrate systematic pain management interventions to address these complexities.

Traditional perioperative management protocols primarily focus on disease treatment itself, often neglecting patients’ psychological and physiological needs, which limits clinical efficacy [20]. Given the characteristics of elderly PHN patients, modern perioperative pain management emphasizes a patient-centered multidimensional intervention model. This approach requires clinical teams to comprehensively assess patients’ pain characteristics, psychological status, and functional needs when formulating treatment plans. By integrating diversified interventions such as psychological counseling and physiological regulation, synergistic therapeutic effects can be achieved, thereby optimizing analgesia, accelerating functional recovery, and improving overall treatment quality [21,22]. The results of this study demonstrate that the observation group exhibited significantly lower HAMA and HAMD scores compared to the control group, indicating that the perioperative pain management protocol effectively improved negative emotional states in elderly PHN patients undergoing PRF treatment. This finding aligns with the conclusions of Abraham’s team [23], whose research similarly noted that elderly patients frequently experience psychological distress during the perioperative period due to health concerns, loss of autonomy, or surgical uncertainty. Their work further confirmed the crucial role of psychosocial interventions in optimizing perioperative management and promoting psychological adjustment and postoperative functional recovery. This therapeutic effect may stem from the following mechanisms: First, healthcare teams establish effective physician-patient communication channels, employing empathetic communication to promptly address patient concerns and effectively alleviate treatment-related anxiety. Second, based on cognitive behavioral therapy principles, targeted psychological interventions address individual emotional triggers, helping patients develop positive disease coping strategies. Finally, by fulfilling patients’ psychological support needs, their treatment confidence and compliance are enhanced. These multilevel psychological interventions not only improve patients’ emotional states but also establish a critical foundation for pain symptom relief and quality of life improvement [24].

This study also revealed that the observation group exhibited significantly higher SF-36 scores across all dimensions after perioperative pain management compared to the control group, while demonstrating markedly lower VAS scores, PSQI total scores, and subscale scores after the intervention. These findings suggest that the systematic perioperative pain management protocol, through its multi-target intervention mechanism, not only significantly alleviates patients’ neuropathic pain symptoms but also effectively enhances overall quality of life and improves sleep disturbances. This comprehensive intervention strategy creates favorable conditions for clinical rehabilitation of PHN patients by simultaneously optimizing both physiological and psychological states. These results are consistent with the conclusions drawn by Azizoddin et al [25] and Huang et al [26], whose studies similarly emphasize the importance of integrating PRF therapy with sleep, pain, and emotional interventions for optimizing postoperative recovery. The observed effects may be attributed to the acupoint drug stimulation therapy employed in the perioperative pain management protocol. This therapy acts on specific acupoints, including Shenmen (HT7), Zhaohai (KI6), and Anmian (Extra), to promote transdermal absorption of pharmacological components, achieving analgesic and sedative effects through the “arrival of qi at the affected site”. In the formulated prescription, cinnamon bark (Cinnamomi Cortex, pungent-warm nature) exerts yang-warming and meridian-dredging effects, while paired with argyi leaf (Artemisiae Argyi Folium, bitter-hot nature) to enhance its cold-dispersing and pain-relieving properties [27]. Combined with the meridian-guiding characteristics of ginger juice (Zingiberis Rhizoma Recens, pungent-slightly warm nature), these herbal components work synergistically to regulate yin-yang balance, improve yang-deficiency syndrome, and consequently resolve stasis to alleviate pain [28]. This external therapy combines the advantages of both internal and external treatment, featuring operational simplicity, high safety, and reliable efficacy [29]. When combined with acupuncture, it can further produce synergistic effects, simultaneously improving pain relief, sleep quality, and overall rehabilitation outcomes [30].

Conclusions

In perioperative management for elderly PHN patients, PRF combined with a comprehensive pain-psychological intervention regimen more effectively alleviated pain, improved anxiety and depression, enhanced quality of life, and improved sleep quality compared to PRF therapy with conventional care alone, demonstrating greater clinical efficacy.

Although this preliminary study suggests that PRF therapy combined with perioperative pain management is effective for elderly PHN patients, several limitations should be acknowledged. First, the small sample size may restrict the generalizability and external validity of the findings. Second, the follow-up period was relatively short (only 3 months), which is insufficient to evaluate the long-term efficacy and safety of the treatment. Additionally, the assessment metrics employed in this study were not comprehensive enough to fully capture changes in patients’ quality of life and psychological status. Finally, the PRF treatment parameters (including voltage, frequency, and duration) were primarily based on previous literature; however, individualized treatment protocols may be required for different patients, necessitating further research to optimize these parameters. Therefore, future studies with larger sample sizes and longer follow-up periods are warranted to validate the therapeutic effects and explore potential improvements in the treatment protocol.