145: Pulsed Radio Frequency on Supraorbital Nerve in Post-Herpetic Neuropathic Pain: A Case Study

Topic: Basic Science
Subtopic: Pain category (ICD-11), Chronic neuropathic pain, , , , , , , , , , Pharmacological interventions, Non-pharmacological interventions

Background and Aims: Post-herpetic trigeminal neuralgia remains the most common causes of facial neuropathic pain. According to its manifestation, neuropathic pain due to herpes zoster infection most likely effect trigeminal nerves, with 75% cases occurred on ophthalmic division of trigeminal nerve. Post-herpetic neuralgia, although seems mild, but the impact in patient’s quality of life can be debilitating. Conservative therapy guideline had been used widely with some benefits, but sometimes, with unwanted side effect of oral therapy. Interventional Pain Management has its role to manage post-herpetic neuralgia accurately and in longer periods of pain-remission.

Methods: A 69-years old woman assessed with Post-herpetic Neuralgia (PHN), hypertension, and Type II Diabetes Mellitus. The neuropathic pain remains high with NRS 9 out of 10 asides from conservative and oral medication for more than one year. Interventional Pain Management approached to the patient with some benefits, ranging from perineural injection therapy with different regenerative agents (dextrose 5% , secretome, and Platelet Rich Plasma). Pain scale was decreased from 9 to 4-5 and the size of pain area was also narrowing. But the sharp and throbbing pain persist, mostly in Supraorbital nerve area.

Results: Therefore, supraorbital nerve injection with local anesthetic was done as a diagnostic block and patient experiencing pain-free period for about 3 weeks. Pulsed Radio Frequency procedure was done to the patient using USG guided injection on supraorbital nerve. Pulsed radiofrequency (PRF) is a percutaneous, micro-invasive, and micro destructive neuromodulation technology. It has been reported to be useful in the treatment of supraorbital neuralgia. Two weeks after procedure, patient’s pain scale significantly declined. And follow up at four until 12 weeks after procedure, patient claimed pain- free episode and now on tapering down oral medication.

Conclusions: Managing Post-Herpetic Neuralgia is challenging and may involve different approached treatment. Although no clear guidelines proposed, combination of conservative therapy, regenerative therapy and different modalities of interventional therapy may be beneficial to generate favorable outcome to relieved chronic neuropathic pain. Pulsed radiofrequency (PRF) has been reported to be useful in the treatment of supraorbital neuralgia. However, the long-term effectiveness needs further studies.

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Presenting Author: Alifa Dimanti
Submitting Author: Alifa Dimanti

Senior Author: Henry Riyanto Sofyan

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Henry Riyanto Sofyan: Dr, SpN-F,MIN, FNK, Subsp.NN(K), FNOnk - RSCM Hospital Jakarta
• Tiara Anindhita: DR.dr. SpS(K) - RSCM Hospital, Jakarta
• Lie Anto: Dr, SpN - RSUD Kabupaten Bintan