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.

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.