Central Desensitisation Sequential to Pulsed Radiofrequency Ablation of Thoracic Dorsal Root Ganglion in Refractory Postherpetic Neuralgia: A Case Report

Postherpetic neuralgia (PHN) is an exceptionally drug-resistant neuropathic pain persisting for 3 months or more after the onset of shingles. PHN most commonly involves the thoracic dermatomes and the ophthalmic division of the trigeminal nerve, with a higher prevalence in elderly and immunocompromised patients. The pain is typically lancinating, sharp, and burning in nature, accompanied by varied degrees of hyperalgesia and allodynia, leading to significant debilitation. We report the case of a 73-year-old woman with intractable pain following shingles. To manage the patient’s severe pain alongside medical treatment, we performed pulsed radiofrequency ablation of the thoracic dorsal root ganglion, followed by central desensitization using intravenous ketamine and lignocaine. Although systematic reviews and meta-analyses exist on PHN interventions, there is limited literature combining interventional strategies with central desensitization. The unique nature of this case and the combination of modalities used in pain relief make this study particularly distinctive.