Comparison of short-term peripheral nerve stimulation, single-target supraorbital nerve pulsed radiofrequency, and dual-target supraorbital nerve-stellate ganglion pulsed radiofrequency for herpes zoster ophthalmicus-associated pain: a retrospective cohort study

Front Neurosci. 2026 Oct 23;20:1976324. doi: 10.3389/fnins.2026.1976324. eCollection 2026.

ABSTRACT

OBJECTIVE: To compare the clinical outcomes of short-term peripheral nerve stimulation (st-PNS), supraorbital nerve pulsed radiofrequency (SON-PRF), and combined supraorbital nerve and stellate ganglion pulsed radiofrequency (SON + SG-PRF) for herpes zoster ophthalmicus (HZO)-associated pain.

METHODS: This retrospective study included patients with HZO-associated pain who underwent st-PNS, SON-PRF, or SON + SG-PRF between January 2023 and January 2026. The primary outcome was the longitudinal change in Numerical Rating Scale (NRS) scores over 24 weeks. Secondary outcomes included the clinical response rate, anxiety (GAD-7), depression (PHQ-9), sleep quality (PSQI), and treatment-related adverse events. The incidence of postherpetic neuralgia (PHN) was assessed as an exploratory outcome only in patients with a disease duration of ≤90 days at treatment. Longitudinal outcomes were analyzed using baseline-adjusted linear mixed-effects models, with propensity score weighting used for sensitivity analyses.

RESULTS: A total of 269 patients were included: 84 in the st-PNS group, 96 in the SON-PRF group, and 89 in the SON + SG-PRF group. NRS scores decreased over follow-up in all three groups. In the primary and both propensity score-weighted analyses, the overall NRS trajectory was lower with st-PNS than with SON-PRF, whereas no significant difference was observed between st-PNS and SON + SG-PRF. The overall GAD-7 trajectory was lower with SON + SG-PRF than with SON-PRF, and the overall PSQI trajectory was lower with SON + SG-PRF than with either st-PNS or SON-PRF; these differences remained statistically significant in both weighted analyses. The overall trajectories of depressive symptoms did not differ significantly among the groups. Exploratory analysis did not establish a difference in PHN risk among the three groups. No serious treatment-related adverse events occurred during follow-up.

CONCLUSION: To our knowledge, this study is the first to compare multidimensional clinical outcomes of st-PNS, SON-PRF, and SON + SG-PRF for HZO-associated pain within the same cohort. st-PNS showed a relatively consistent analgesic benefit over SON-PRF, whereas SON + SG-PRF also provided analgesia and showed potential benefits for anxiety and sleep outcomes. These findings require confirmation in prospective studies.

PMID:42996710 | PMC:PMC13739791 | DOI:10.3389/fnins.2026.1976324