Treatment of Trigeminal Zoster–Associated Pain With Burst and Tonic Trigeminal Ganglion Stimulation: A Retrospective Study

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PURPOSE: Evidence regarding the efficacy of trigeminal ganglion stimulation for refractory trigeminal zoster-associated pain (TZAP) is limited. This study investigated the use of percutaneous trigeminal ganglion stimulation in a series of TZAP patients and evaluated the efficacy of burst trigeminal ganglion stimulation (bTGS) and tonic trigeminal ganglion stimulation (tTGS) modalities on pain relief. PATIENTS AND METHODS: We retrospectively reviewed all eligible TZAP patients who received temporary trigeminal ganglion stimulation in our department between January 2022 and August 2024. Spontaneous pain and mechanical allodynia intensity were assessed using the numeric rating scale (NRS) before treatment and at 1 week, the day of electrode removal, 1 month, 2 months, and 3 months post-treatment. Other symptoms, pain interference with sleep, and scores on the self-rating depression scale and self-rating anxiety scale were also recorded. RESULTS: Among 31 patients, 16 received tTGS and 15 received bTGS. Compared with baseline, there was a statistically significant decrease in spontaneous pain NRS scores at 3 months (mean difference, 5.0; 95% CI, 4.2-5.8; p < 0.001). Similarly, the proportion of patients with mechanical allodynia NRS scores 3 or less increased significantly at 3 months (difference in proportions, 61.3%; 95% CI, 42.2%-80.4%; p < 0.001). In the tTGS group, the mean spontaneous pain NRS score decreased from 8.1 (95% CI, 7.5-8.8) at baseline to 3.2 (95% CI, 1.8-4.6) at 3 months (p < 0.001). In the bTGS group, the mean spontaneous pain NRS score decreased from 7.3 (95% CI, 6.6-8.1) at baseline to 2.3 (95% CI, 1.2-3.3, p < 0.001) at 3 months (p < 0.001). No serious adverse events occurred. CONCLUSION: This retrospective study suggests that trigeminal ganglion stimulation is a promising therapeutic option for patients with TZAP and that bTGS may serve as a feasible alternative.

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