Spinal cord stimulation, peripheral nerve stimulation, and pulsed radiofrequency in the management of herpes zoster–related pain: a network meta-analysis

BACKGROUND: Neuromodulation therapy is gaining importance in managing chronic neuropathic pain. This network meta-analysis aims to compare the efficacy and safety of spinal cord stimulation (SCS), peripheral nerve stimulation (PNS), pulsed radiofrequency (PRF), and their combinations in the management of herpes zoster (HZ)-related pain. METHODS: We searched Scopus, Cochrane CENTRAL, PubMed, and Web of Science from inception until August 27, 2025. Clinical trials and observational studies evaluating the efficacy and safety of SCS, PNS, PRF, or their combinations in HZ-related pain were included. Mean difference (MD) and risk ratio (RR) with corresponding 95% confidence intervals (CIs) were pooled. RESULTS: Eleven studies (1035 patients) were included. When compared to the reference group (PRF), SCS+PRF achieved the greatest reduction in pain intensity (MD: -3.58 points, 95% CI: -5.05 to -2.12) and the highest treatment success rate (RR: 2.54, 95% CI;: 1.45 to 4.45). PNS+PRF demonstrated the most significant improvement in Pittsburgh Sleep Quality Index (PSQI) score (MD: -1.75 points, 95% CI: -3.24 to -0.27), while SCS alone showed the greatest reduction in pregabalin dose (MD: -36.58 mg, 95% CI: -68.93 to -4.24), physical role (MD: 9.70 points, 95% CI: 6.21 to 13.19), and bodily pain (MD: 8.42 points, 95% CI: 2.10 to 14.73) domains of the Short Form-36 (SF-36) score, while no significant differences were observed among the interventions regarding the physical function domain. CONCLUSION: Combination neuromodulation therapies, particularly SCS+PRF, may provide superior pain relief. PNS+PRF and PNS also showed marked improvements in sleep quality, whereas SCS was most effective in reducing pregabalin use and enhancing SF-36 scores.