The investigators are conducting a clinical study with the following objectives: to evaluate the clinical efficacy of electroacupuncture combined with pregabalin in treating Postherpetic Neuralgia(PHN); to investigate the correlation between serum biomarker levels and pain symptoms;and to determine whether serum biomarkers can serve as prognostic indicators for PHN. This study utilizes a randomized controlled trial design with assessor blinding. A total of 207 eligible PHN patients were randomly assigned to three groups in a 1:1:1 ratio: the electroacupuncture group, the pharmacotherapy group, and the sham acupuncture group. Comparative analyses of pain intensity and serum biomarker concentrations were conducted across these groups. For the assessment of clinical outcomes, the investigators employed the following measures: the Numerical Rating Scale(NRS), the Hamilton Anxiety Scale(HAMA), the Hamilton Depression Scale(HAMD), the 36-Item Short Form Health Survey(SF-36), serum levels of substance P(SP)and Neuropeptide Y(NPY), and inflammatory markers(IL-10,TNF-α). These assessments were performed at baseline and at the end of weeks 1, 2, 3, and 4 of treatment. The investigators anticipate that this clinical trial will enhance our understanding of the therapeutic efficacy and underlying mechanisms of acupuncture in managing PHN. It aims to elucidate the relationship between serum biomarkers and the clinical manifestations of PHN, as well as to explore their potential prognostic value in disease outcomes.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
207
Acupoint prescription: The therapeutic protocol utilized Ashi points (localized to herpetic lesion areas) and Jiaji points (EX-B2, ipsilateral to affected dermatomes). Acupuncture procedure: For Ashi points, sterile disposable needles (0.25 mm diameter, 40 mm length) were inserted at a 15° angle to a depth of 15-20 mm, without deqi sensation or manual manipulation. For Jiaji points (EX-B2), needles (0.30 mm diameter, 50 mm length) were inserted perpendicularly to a depth of 40-45 mm, with twisting manipulation (90° rotation at 90 cycles/min) until patients felt soreness, numbness, or distension. Electroacupuncture was applied using the Hans-100A device, with dense-disperse wave mode (2/100 Hz) and intensity adjusted to patient tolerance, for 30 minutes.
Patients received protocol-guided therapy consisting of: ① Pregabalin: Initial dose 75 mg twice daily. Dose may be titrated upward to 150 mg twice daily within one week based on therapeutic response and tolerability. Gradual discontinuation is recommended when clinically appropriate, tapered by 100 mg decrements every 3-7 days. ② Methylcobalamin: 5 mg three times daily.
The Streitberger needle, a widely reported placebo needle device in acupuncture RCTs, was applied for sham intervention. This telescoping blunt-tip needle achieves non-penetrating placebo stimulation through its retractable design. Its key advantage lies in evoking a skin-penetrating sensation akin to true needling through tissue compression, while avoiding actual dermal perforation to minimize specific therapeutic effects. Following the perception of needle insertion reported by patients, the device is retracted by approximately 1 mm and connected to electroacupuncture apparatus without electrical stimulation activation.
The Third Affiliated Hospital of Zhejiang Chinese Medical University
Hangzhou, Zhejiang, China
Assessing the participants' pain intensity by the Numerical Rating Scale
Pain intensity was assessed using the Numerical Rating Scale (NRS), an 11-point scale ranging from 0 ("no pain") to 10 ("intolerable pain"). This validated tool demonstrates rapid clinical utility and robust psychometric properties, including good reliability and validity in pain assessment.
Time frame: Assessments were performed at baseline and at the end of weeks 1, 2, 3, and 4 of treatment.
The number of pain episodes in the past 24 hours
Daily documentation of pain episodes over 24-hour intervals to characterize symptom fluctuation patterns.
Time frame: Assessments were performed at baseline and at the end of weeks 1, 2, 3, and 4 of treatment.
Psychological Status Assessment: Hamilton Anxiety Scale 36 ( HAMA )
Hamilton Anxiety Scale36 (HAMA): A 14-item clinician-administered tool evaluating anxiety severity across domains such as anxious mood, tension, and insomnia. Scores ≥14 indicate clinically significant anxiety.
Time frame: Assessments were performed at baseline and at the end of weeks 1, 2, 3, and 4 of treatment.
Psychological Status Assessment: Hamilton Depression Scale37 (HAMD-21)
Hamilton Depression Scale37 (HAMD-21): A 21-item instrument assessing core depressive symptoms spanning affective, cognitive, and somatic dimensions. Assessments were performed at baseline and at the end of weeks 1, 2, 3, and 4 of treatment.
Time frame: Assessments were performed at baseline and at the end of weeks 1, 2, 3, and 4 of treatment.
The health-related quality of participants' life is assessed by The Short-Form 36 Health Survey
The Short-Form 36 Health Survey (SF-36) quantified health-related quality of life across 8 domains (e.g., physical function, social role). This instrument has been extensively validated in chronic pain research.
Time frame: Assessments were performed at baseline and at the end of weeks 1, 2, 3, and 4 of treatment.
Neuroregeneration Indicators: Neuropeptide Y (NPY)
Neuropeptide Y (NPY) , a mediator of neuro-immune crosstalk and synaptic remodeling.
Time frame: Assessments were performed at baseline and at the end of weeks 1, 2, 3, and 4 of treatment.
Neuroregeneration Indicators: Substance P (SP)
Substance P (SP), a tachykinin modulating nociceptive signaling.
Time frame: Assessments were performed at baseline and at the end of weeks 1, 2, 3, and 4 of treatment.
Inflammatory Markers : TNF-α
TNF-α, a proinflammatory cytokine.
Time frame: Assessments were performed at baseline and at the end of weeks 1, 2, 3, and 4 of treatment.
Inflammatory Markers : IL-10
IL-10, an anti-inflammatory cytokine.
Time frame: Assessments were performed at baseline and at the end of weeks 1, 2, 3, and 4 of treatment.
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