Abstract: Objective To evaluate the effect of pulsed radiofrequency (PRF) on the treatment duration of patients with postherpetic neuralgia (PHN) and to identify other factors associated with treatment duration.Methods This was a single-center retrospective cohort study. We included 216 PHN patients who were initially hospitalized in Department of Anesthesiology and Pain Medicine, Wuxi Second People's Hospital, between January 2019 and May 2024. The patients were divided into the PRF group (n=105) and the observation group (OB group, n=111). The primary endpoint for treatment discontinuation was defined as a reduction in the Numeric Rating Scale (NRS) score of≥50% with NRS≤3, maintained for at least two weeks. A landmark time point of 14-day post-admission was set. Baseline differences were adjusted using stabilized inverse probability of treatment weighting (sIPTW). Time to treatment discontinuation (TTD) was analyzed by the Kaplan-Meier method, and a Cox model was used to identify factors influencing treatment duration.Results After sIPTW adjustment, baseline characteristics were well balanced (all standardized mean differences SMD<0.1). The median TTD in the PRF group (12 months) was significantly shorter than that in the OB group (not reached; log-rank P=0.016). From 12 to 48 months, the restricted mean TTD difference between the two groups ranged from 1.79 to 7.35 months (P<0.05), and at 60 months the difference reached 8.34 months (P>0.05). Multivariable analysis showed that PRF promoted treatment discontinuation (HR=2.27, 95%CI: 1.42-3.62). In contrast, chronic-phase onset (HR=0.12), prodromal pain (HR=0.56), severe skin lesions or a history of lesion infection (HR=0.30), smoking history (HR=0.51), and receipt of traditional Chinese medicine treatment (HR=0.34) were independent risk factors for delayed treatment discontinuation.Conclusions PRF can significantly shorten the treatment duration of PHN within 4 years, but its long-term effect on shortening duration is not significant. It is necessary to enhance intervention strategies for PHN patients with chronic-phase onset, prodromal pain, severe skin lesions or infection history, and a smoking history.