617: Comparison of Efficacy and Safety of Non-Oral Therapeutic Interventions for Zoster-Associated Pain

Topic: Education, Societal Impact, and Others
Subtopic: Methodology others

Background and Aims: Zoster-associated pain (ZAP) encompasses acute, subacute, and postherpetic neuralgia stages. It often results in persistent sensory abnormalities and substantial impairment of quality of life. Although oral pharmacotherapy remains the first-line and foundational approach, its effectiveness may be limited in some patients; accordingly, non-oral interventions are investigated as complementary or escalated strategies. However, high-quality evidence investigating the relative efficacy and safety of these interventions remains scarce.
This study intended to systematically evaluate the efficacy and safety of a variety of non-oral therapeutic interventions for ZAP, thereby providing evidence to inform clinical decision-making.

Methods: Web of Science, Cochrane Library, Embase, and PubMed were searched to identify eligible randomized controlled trials (RCTs). Data from the included studies were extracted, and the risk of bias was examined via the Cochrane Risk of Bias Tool 2.0. A Bayesian network meta-analysis (NMA) was carried out to compare different interventions, and surface under the cumulative ranking curve (SUCRA) probabilities were utilized to rank relative treatment effects. STATA 18 and R version 4.4.2 were employed to conduct statistical analyses.

Results: Fifty-three RCTs with 4,973 patients indicated that chemical selective neurolysis offered the best pain relief (SMD: 4.34; 95% CrI: 2.18-6.49) without significant adverse events (AEs) increase (risk ratio: 32.05; 95% CrI: 0.57-3,326.64), though uncertainty was high. No serious complications occurred. Minimally invasive central nervous system neuromodulation with topical and peripheral interventions showed the best benefits for pain relief (SMD: 3.41; 95% CrI: 1.08-5.73) and sleep improvement (SMD: 3.71; 95% CrI: 1.86-5.77), followed by peripheral nerve modulation with systemic analgesia. Safety profiles favored oral medication and minimally invasive neuromodulation.

Conclusions: Combination therapies utilizing minimally invasive neuromodulation show favorable potential in managing ZAP. While chemical selective neurolysis may benefit refractory cases, its use necessitates careful ethical and safety evaluation. Due to the low overall certainty of the evidence, these findings should be interpreted with caution, underscoring the critical need for rigorous future research to confirm long-term outcomes.

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Presenting Author: Hao Yuchen
Submitting Author: Yuchen Hao

Senior Author: Sun Tao

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Liu Xiange: Master of Medicine (in progress) - Shandong Provincial Hospital
• Ma Xinyi: Master of Medicine (in progress) - Shandong Provincial Hospital
• Sun Tao: PhD - Shandong Provincial Hospital