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Background: Zoster-associated pain (ZAP) is often refractory to conventional treatments and can seriously affect patients' physical and mental health. High-voltage pulsed radio frequency (H-PRF) is a new method for treating ZAP with pulse voltages above 60 V or even up to 100 V. The purpose of this paper was to conduct a systematic review and meta-analysis to evaluate the efficacy of H-PRF in the management of ZAP. Methods: PubMed, Embase, and the Cochrane library were searched from their inception to June 2022 to identify controlled trials which evaluated the effectiveness of H-PRF compared with standard PRF and sham operations. The primary outcome was pain scores at different treatment times. The secondary outcomes included SF-36 scores, rescue analgesic dose, and side effects. Results: We reviewed 6 randomized controlled trials involving 428 patients. There was no significant difference between the H-PRF and standard PRF pain scores at 1 week after surgery and the sham operation group at 1 month. At 1, 3, and 6 months, the H-PRF group had better pain score than the standard PRF group, and at 3 months, the pain score was better than the sham operation group. The H-PRF group showed improvement in the SF-36 score, and there were no significant complications in the H-PRF group. Conclusions: H-PRF is an effective and safe treatment method that has better effects in relieving pain and improving the quality of life and physical and mental health. Although H-PRF provides pain relief rates comparable to those of the control group in the early stages, it remains the preferred and alternative treatment for relieving herpes zoster-related pain.
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BACKGROUND: Percutaneous transforaminal endoscopic discectomy (PTED) has been widely used in the treatment of lumbar degenerative diseases. Epidural injection of steroids can reduce the incidence and duration of postoperative pain in a short period of time. Although steroids are widely believed to reduce the effect of surgical trauma, the observation indicators are not uniform, especially the long-term effects, so the problem remains controversial. Therefore, the purpose of this paper was to evaluate the efficacy of epidural steroids following PTED. METHODS: We searched PubMed, Embase, and the Cochrane Database from 1980 to June 2021 to identify randomized and non-randomized controlled trials comparing epidural steroids and saline alone following PTED. The primary outcomes included postoperative pain at least 6 months as assessed using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). The secondary outcomes included length of hospital stay and the time of return to work. RESULTS: A total of 451 patients were included in three randomized and two nonrandomized controlled trials. The primary outcomes, including VAS and ODI scores, did not differ significantly between epidural steroids following PTED and saline alone. There were no significant intergroup differences in length of hospital stay. Epidural steroids were shown to be superior in terms of the time to return to work (P < 0.001). CONCLUSIONS: Intraoperative epidural steroids did not provide significant benefits, leg pain control, improvement in ODI scores, and length of stay in the hospital, but it can enable the patient to return to work faster.
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PURPOSE: Calcium/calmodulin-dependent protein kinase (CaMK) II and its downstream effector cyclic adenosine monophosphate (cAMP) responsive element binding protein (CREB) may be involved in the development of neuropathic pain. The aim of this study was to examine the effect of the CaMKII inhibitor AIP on the association of CaMKII and CREB in a partial sciatic nerve ligation neuropathic pain model in rats. METHODS: Male Sprague-Dawley rats were randomly divided into six groups: Sham operation; partial sciatic nerve ligation (SNL); AIP administration prior to or after SNL; and normal saline (NS) administration prior to or after SNL. NS or 10 µmol/L AIP (10 µl) were injected intrathecally in the NS group and AIP group, respectively, 20 min before or 4 days after nerve injury. The mechanical withdrawal threshold of the hindpaw was measured before and after SNL. In another cohort treated as above, the lumbar spinal cord was removed on post-surgery days 1, 3, and 7 to detect the expression of phosphorylated CaMKII (pCaMKII) and phosphorylated CREB (pCREB), by in situ immunostaining and western blot, respectively. RESULTS: AIP significantly suppressed tactile allodynia in the SNL rats, and its effects lasted for 3 days when given prior to nerve injury. In contrast, it had a transitory effect when given after nerve injury. AIP decreased the expression of pCaMKII and pCREB and its effect was sustained for up to 3 days after the experiments. CONCLUSION: Intrathecal injection of a CaMKII inhibitor attenuated neuropathic pain. This benefit may have been due to the downmodulation of its downstream effector pCREB.