High-Voltage Pulsed Radiofrequency Neuromodulation as Monotherapy for Postherpetic Neuralgia: A Case Report.

BACKGROUND: Postherpetic neuralgia (PHN) management remains suboptimal, and many patients rely on systemic medications with limited efficacy and tolerability, particularly in older adults. Pulsed radiofrequency (PRF) is used as a neuromodulatory option, but optimal dosing parameters remain uncertain. CASE REPORT: A 72-year-old patient with refractory thoracic PHN (Visual Analog Scale [VAS] 8/10, 5-week duration) underwent computed tomography (CT)-guided PRF at the T4-T5 dorsal root ganglia (DRG) using escalated parameters (90 V, 45°C, 20-millisecond pulse width, 10-minute duration). No perineural injectates or pharmacologic adjuvants (e.g., corticosteroids, long-acting local anesthetics, or neurotrophic agents) were used; only a small amount of 1% lidocaine was used for skin infiltration. Immediate pain reduction to VAS 3/10 was achieved, progressing to 1/10 at one month. Gabapentin and lidocaine patches were discontinued after the procedure, with an 85% reduction in dermatomal hypersensitivity. No sensory deficits or complications were observed during follow-up. CONCLUSIONS: Our case provides hypothesis-generating evidence that CT-guided, high-parameter PRF (90 V, 45°C, 20 milliseconds, 10 minutes) delivered to the thoracic DRG can be associated with substantial short-term pain relief in subacute PHN without adjunct pharmacotherapy. Given the single-patient, uncontrolled design and one month follow-up, the findings should be interpreted cautiously and require confirmation in prospective studies with longer observation.