Thoracic Radiofrequency Sympathectomy for Postherpetic Neuralgia

Postherpetic neuralgia (PHN) is a chronic neuropathic pain condition that may follow herpes zoster infection and is often difficult to treat with conventional medical therapy. Elderly patients are particularly vulnerable and may experience severe functional and psychological impairment. We report the case of a 73-year-old male with refractory PHN involving the upper thoracic dermatomes, who achieved significant pain relief following fluoroscopy-guided T2–T3 thoracic radiofrequency (RF) sympathectomy. This case highlights the role of interventional pain management (MIPSI) in patients with PHN unresponsive to pharmacological treatment. Despite receiving treatment with gabapentin, nortriptyline, topical medications, antivirals, and oral corticosteroids, the patient’s acute neuropathic pain persisted for 10 months. The Visual Analog Scale was used to measure baseline pain level (Visual Analog Scale [VAS]: 8/10), and the DN4 questionnaire was used to screen for neuropathic pain (DN4 score: 6/10). The Patient Health Questionnaire (PHQ)-9 was used to measure psychological discomfort (14/27). The patient reported improved sleep and everyday functioning after RF sympathectomy, along with a considerable reduction in pain (VAS: 3/10 after 24 h). At follow-up appointments at 1 week, 1 month, 3 months, and 6 months, sustained effect was observed, with decreased analgesic needs and an improved PHQ-9 score (6/27 at 6 months). No major complications were observed. The present case implies that some patients with refractory PHN affecting upper thoracic dermatomes may benefit from thoracic RF sympathectomy. However, additional controlled studies are needed to determine its effectiveness, safety, and comparative relevance among interventional modalities due to the limits of a single-case observation and the existence of potential confounding factors.