Burstvs.tonic SCS for early zoster-associated pain: A retrospective cohort study

Objective: Inadequate pain control during early zoster-associated pain (ZAP) can lead to postherpetic neuralgia (PHN), and traditional treatments have limitations. This retrospective analysis compares the analgesic effects of burst (BurstSCS) versus traditional tonic (TonicSCS) spinal cord stimulation in early ZAP patients, using retrospective data. It also evaluates differences in psychological state and sleep quality. The findings offer insights into the multidimensional effects of these SCS modalities for future research. Methods: Retrospective analysis included 40 consecutive early ZAP patients undergoing SCS trial (From March 1, 2023 to March 1, 2025). Groups: BurstSCS (n=20) vs. TonicSCS (n=20) based on documented treatment selection. Outcomes assessed at baseline, 14, and 30 days: visual analog scale (VAS) , Pittsburgh Sleep Quality Index (PSQI), Pain Vigilance and Awareness Questionnaire (PVAQ). Intergroup comparisons used independent t-tests (significant at P<0.05). Results: At 14 days, BurstSCS achieved greater pain reduction (VAS: 1.95±0.76 vs 2.65±0.75; *P*=0.006) and better secondary outcomes:PSQI: 7.00±2.08 vs 8.90±1.89,PVAQ: 15.55±2.80 vs 22.20±2.42,(all *P*<0.05). At 30 days, VAS was comparable (1.40±1.23 vs 1.80±0.95) but BurstSCS maintained lower PSQI (4.90±1.33 vs 5.85±1.60) and PVAQ (9.00±1.56 vs 18.50±2.16) (*P*<0.05). Conclusions: BurstSCS provided superior early pain reduction (>70% VAS decrease at 14 days) and sustained improvements in sleep quality and pain vigilance in early ZAP patients. These findings support its potential for multidimensional symptom management, warranting validation through prospective trials.