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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

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.

Last updated: Aug 5, 2026•1 RCTs•📖 Read as article →

Evidence Score

Evidence Score44/100
Human RCT★★☆☆☆
Meta-analysis☆☆☆☆☆
Mechanism★★★★★
Safety★★★★☆
Confidencelow

Study Evidence

Study 1. The Effect of Esketamine Combined with Pulsed Radiofrequency on Neuropathic Pain in Herpes Zoster Patients: A Randomised Clinical Trial.

observational

Wang D, Gai Q, Zhang Y, Yan Z, Hu B, Feng Z · Pain and therapy (2026)

Participants: N/A
Duration: 3 months follow-up
Intervention: Continuous low-dose esketamine (0.02 mg/kg/h for 48 h) combined with pulsed radiofrequency (PRF) and standard anticonvulsants
Outcome: Pain intensity (NRS), neuropathic pain (ID-pain), anxiety (HAMA), depression (HAMD-24), sleep quality (PSQI), dissociative symptoms (CADSS), adverse events
Effect Size: N/A (specific effect sizes not reported in abstract)
Population: 60 patients with zoster-related neuralgia scheduled for PRF

Result:

PubMed: 42538490DOI: 10.1007/s40122-026-00868-1

Mechanism Graph

Esketamine blocks N-methyl-D-aspartate (NMDA) receptors, reducing central sensitization and neuropathic pain.
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Pulsed radiofrequency modulates nerve signaling and reduces pain transmission.
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Combined effects lead to enhanced pain relief and improved mood and sleep.
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Result: Significant pain reduction and improved psychological and sleep outcomes without increased dissociative symptoms.

Limitations

  • ⚠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.

Products

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References

  1. 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
Disclaimer: This content is for educational purposes only and is not medical advice. Evidence scores reflect the quality and quantity of available research, not clinical recommendations. Always consult a healthcare professional before starting any supplement or intervention.