Objective Exploring the efficacy and safety of botulinum toxin type A （BTX?A） combined with pulsed radiofrequency（PRF） in the treatment of postherpetic neuralgia（PHN）. Methods A total of 80 patients with PHN were collected. They were randomly divided into experimental group （Group B）and control group （Group C）， Group B was treated with BTX?A intradermal injection combined with PRF， and Group C was treated with lidocaine intradermal injection combined with PRF. Numeric pain score （NRS）， Simplified McGill Pain Questionnaire （SF?MPQ）and Sleep Quality Score （QS）were used to assess the patients' pain level and sleep quality preoperatively， 1， 3， and 7 days postoperatively， and 1， 2， and 3 months postoperatively. The patients' postoperative adverse reactions were collected. Interleukin?1β （IL?1β）and calcitonin gene?related peptide （CGRP）levels in patients' serum were measured preoperatively and 3 days postoperatively. Results The NRS scores， SF?MPQ scores， and QS scores of group B and group C were significantly lower at all postoperative time points compared to preoperative ones （P < 0.05）. The NRS and SF?MPQ score were significantly lower in group B at 1， 2， and 3 months postoperatively compared with group C（P < 0.05）； and group B had significantly lower QS scores at 2 and 3 months postoperatively （P < 0.05）. The effective rate of pain relief at 3 months postoperatively in group B （90%） was statistically significant （P < 0.05） compared with group C （56.7%）. No serious adverse reactions occurred in either group. The levels of IL?1β and CGRP in serum of patients in both groups were significantly decreased at 3 days after surgery compared with the preoperative period， and the degree of decrease of IL?1β and CGRP in group B was more significant than that in group C （P < 0.05）. Conclusion BTX?A combined with PRF treatment for PHN can effectively reduce its pain level， improve the quality of sleep， and is safe.