187: BTX-A Subcutaneous Injection Combined with SCS for PHN: An Efficacy Observation

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic neuropathic pain, Assessment and Measurement of Pain/Nociception, Neuromodulation (e.g. TMS, TDCS, FUS, SCS, MCS, DBS, vagus nerve stimulation)

Background and Aims: Botulinum toxin type A (BTX-A) and spinal cord stimulation (SCS) treat postherpetic neuralgia (PHN) via peripheral and central mechanisms, respectively. Combining both may enable multi-target synergy, yet clinical evidence remains limited. This study evaluates the efficacy of BTX-A + SCS in PHN patients to inform practice.

Methods: This retrospective study included PHN patients from the Fourth Affiliated Hospital of Harbin Medical University between September 1, 2024 and September 30, 2025. Participants were assigned to four treatment groups: paravertebral nerve block (PVB), subcutaneous botulinum toxin type A (BTX-A), spinal cord stimulation (SCS), or BTX-A+SCS. All received conventional pharmacotherapy and paravertebral block. Outcomes including Visual Analogue Scale (VAS), Pittsburgh Sleep Quality Index (PSQI), Self-rating Anxiety Scale (SAS) scores, and pregabalin dosage were measured before treatment and at 1 week, 2 weeks, 1 month, and 3 months post-treatment.

Results: All groups showed significantly decreased VAS, PSQI, and SAS scores post-treatment vs baseline (P<0.05). At 1 week, BTX-A+SCS provided superior pain and sleep improvement over PVB and BTX-A. From 1 month onward, BTX-A+SCS achieved significantly better pain and anxiety relief than all other groups (P<0.05). At 3 months, BTX-A+SCS had the lowest scores and highest pregabalin reduction rate (94.12%). Adverse reactions were mild.

Conclusions: The combined therapy of botulinum toxin type A subcutaneous injection and spinal cord stimulation can significantly alleviate pain, improve sleep quality, reduce anxiety levels, and decrease the usage of oral medications in patients with PHN.

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Presenting Author: zhuohang Li
Submitting Author: huacheng zhou

Senior Author: Huacheng Zhou

IASP 2026 Global Year theme of Neuropathic Pain: Yes