Short-term spinal cord stimulation vs. pulsed radiofrequency in acute/subacute herpes zoster pain

Context Acute and subacute zoster-related pain (ZRP) may progress to postherpetic neuralgia (PHN), yet comparative real-world evidence for early neuromodulation remains limited. Objectives To compare the clinical outcomes of short-term spinal cord stimulation (stSCS) and pulsed radiofrequency (PRF) in patients with acute/subacute ZRP. Methods In this retrospective single-center cohort study, 421 patients with acute/subacute ZRP treated with stSCS ( n = 167) or PRF ( n = 254) between 2020 and 2023 were included. Outcomes included pain intensity assessed by the Numeric Rating Scale (NRS), treatment response, residual ZRP and PHN incidence, sleep quality assessed by the Athens Insomnia Scale (AIS), activities of daily living (ADL), and complications. Results Both treatments were associated with significant pain reduction during follow-up. Compared with PRF, stSCS achieved lower NRS scores at 2 weeks and 1 month (both p < 0.001), and higher responder rates at 2 weeks (80.2% vs. 50.8%) and 1 month (92.2% vs. 75.6%; both p < 0.001). At 3 months, responder rates remained higher with stSCS (97.6% vs. 92.9%, p = 0.043), whereas by 6 months response rates were similarly high in both groups (98.8% vs. 98.0%, p = 0.708). PHN incidence was lower in the stSCS group (7.2% vs. 20.9%, p < 0.001). In multivariable adjusted analyses, stSCS remained associated with a lower risk of PHN incidence. Sleep quality improved in both groups, with greater AIS improvement after stSCS (all post-treatment p < 0.001), while ADL improvement was comparable. No permanent neurological deficit or device-related infection occurred. Three mild pneumothorax cases after thoracic PRF resolved with conservative management. Conclusion Short-term spinal cord stimulation was associated with faster early pain relief, greater sleep improvement, and lower incidences of residual ZRP and PHN than PRF in acute/subacute ZRP.