Impacts of Pain Characteristics on the Outcomes of Short-Term Spinal Cord Stimulation for the Treatment of Post-Herpetic Neuralgia: A Prospective Self-Controlled Study.

Background: Herpes zoster and postherpetic neuralgia are increasingly prevalent and associated with substantial pain burden and reduced quality of life. Despite the increasing use of neuromodulation strategies such as stSCS, evidence on their effects across pain phenotypes remains limited. Aim: To investigate the heterogeneous pain characteristics of postherpetic neuralgia and to explore how different pain phenotypes respond to stSCS. Design: A prospective self-controlled study. Methods: LCA was used to identify different pain phenotypes, followed by LMM to evaluate differential responses after stSCS in pain, anxiety, ADL and sleep. The report was guided by the STROBE checklist. Results: A total of 207 patients were included. StSCS was effective in improving pain, anxiety and sleep status in patients with PHN, although a reduction in ADL was also observed. LCA identified two distinct pain phenotypes: Typical irritative phenotype (Class 1) and Atypical high-burden phenotype (Class 2). Differential treatment responses were observed between the two phenotypes, with Class 1 showing greater pain relief and sleep improvement, whereas Class 2 exhibited a higher symptom burden and a comparatively weaker response to stSCS. Conclusion: This study confirms the clinical efficacy of stSCS in patients with PHN and demonstrates heterogeneity in treatment response across distinct pain phenotypes. These findings underscore the importance of pre-treatment pain phenotype stratification to inform individualized stSCS-based management strategies and support the integration of a multidisciplinary approach for high-burden phenotypes to optimize therapeutic outcomes.