Low-dose esketamine combined with pulsed radiofrequency reduces neuropathic pain and improves mood and sleep quality in herpes zoster patients with zoster-related neuralgia
In a randomized controlled trial of 60 patients with zoster-related neuralgia, continuous esketamine (0.02 mg/kg/h for 48 h) combined with pulsed radiofrequency (PRF) significantly reduced pain scores (NRS and ID-pain) at all post-treatment time points up to 3 months compared to PRF plus saline. Depression (HAMD-24) and sleep quality (PSQI) improved significantly from 48 hours through 12 weeks, while anxiety (HAMA) improved from 1 week onward. No significant differences in dissociative symptoms or adverse events were observed.
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Low-dose esketamine combined with pulsed radiofrequency reduces neuropathic pain and improves mood and sleep quality in herpes zoster patients with zoster-related neuralgia The current body of evidence comprises 1 study, including 1 randomized controlled trial. EvidenceHub rates the overall confidence at 44/100 (low).
The Claim
Low-dose esketamine combined with pulsed radiofrequency reduces neuropathic pain and improves mood and sleep quality in herpes zoster patients with zoster-related neuralgia
This conclusion is most relevant to: 60 patients with zoster-related neuralgia scheduled for PRF.
What the Research Shows
The conclusion draws on 1 linked study. Highlights from the cited literature:
- ▸The Effect of Esketamine Combined with Pulsed Radiofrequency on Neuropathic Pain in Herpes Zoster Patients: A Randomised Clinical Trial. (Pain and therapy, 2026) —
How It Works
The proposed biological pathway:
- ▸Esketamine blocks N-methyl-D-aspartate (NMDA) receptors, reducing central sensitization and neuropathic pain.
- ▸Pulsed radiofrequency modulates nerve signaling and reduces pain transmission.
- ▸Combined effects lead to enhanced pain relief and improved mood and sleep.
- ▸Result: Significant pain reduction and improved psychological and sleep outcomes without increased dissociative symptoms.
Who Might Benefit
Evidence fit by population:
- ▸60 patients with zoster-related neuralgia scheduled for PRF
Recommended Dose
0.02 mg/kg/h for 48 hours
Limitations & Caveats
Important context when interpreting this evidence:
- ▸Single-center study with relatively small sample size (n=60).
- ▸Follow-up limited to 3 months; long-term efficacy and safety not assessed.
- ▸No placebo control for PRF itself; all patients received PRF.
- ▸Potential unblinding due to esketamine's psychoactive effects, despite no significant CADSS differences.
Frequently Asked Questions
What is the recommended dose of esketamine for zoster-related neuralgia?▼
The study used a continuous low-dose esketamine infusion of 0.02 mg/kg/h for 48 hours, combined with pulsed radiofrequency and standard anticonvulsants.
How long does the pain relief last after esketamine combined with PRF?▼
Pain scores were significantly lower at all post-treatment time points up to 3 months (the end of follow-up).
Does esketamine cause dissociative symptoms in this context?▼
No significant differences in CADSS scores (measuring dissociative symptoms) were observed between the esketamine and saline groups, indicating a favorable safety profile at the low dose used.
What is the study design and sample size?▼
This was a randomized controlled trial with 60 patients with zoster-related neuralgia, all of whom completed the study.
References
- 1.Wang D, Gai Q, Zhang Y, Yan Z, Hu B, Feng Z. “The Effect of Esketamine Combined with Pulsed Radiofrequency on Neuropathic Pain in Herpes Zoster Patients: A Randomised Clinical Trial..” Pain and therapy, 2026. PMID: 42538490 DOI: 10.1007/s40122-026-00868-1