Comparing cold-air analgesia, systemically administered analgesia and scalp nerve blocks for pain management during photodynamic therapy for actinic keratosis of the scalp presenting as field cancerization: a randomized controlled trial

Klein, Annette; Karrer, Sigrid; Hörner, Christian; Werner, A.; Heinlin, J.; Zeman, Florian; Koller, Michael; Landthaler, Míchael; Szeimies, R.–M.; Gruber, Michael; Graf, Bernhard M.; Hansen, Ernil; Kerscher, C.

doi:10.1111/bjd.13547

Cited by 26 publications

(18 citation statements)

References 37 publications

(38 reference statements)

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“…Similar results were achieved in another three independent studies, with ΔVAS ranging from −4·2 to −6·3 . Compared with other pain management methods such as cold air and oral analgesia, nerve block is significantly more effective …”

Section: Pain Managementsupporting

confidence: 83%

“…More specifically, anaesthesia should be given to trigeminal branches of the supraorbitalis, supratrochlearis, infraorbitalis and mentalis . Similar results were achieved in another three independent studies, with ΔVAS ranging from −4·2 to −6·3 . Compared with other pain management methods such as cold air and oral analgesia, nerve block is significantly more effective …”

Section: Pain Managementsupporting

confidence: 64%

“…Gholam's group recommend 800 mg of ibuprofen administered 30 min before exposure . Other anti‐inflammatory anaesthetic agents, such as metamizole and acetaminophen, have also been used and are reported in several studies . A comprehensive, placebo‐controlled clinical trial would be useful to determine their efficacy.…”

Section: Pain Managementmentioning

confidence: 99%

“…24,66,67 Other anti-inflammatory anaesthetic agents, such as metamizole and acetaminophen, have also been used and are reported in several studies. 23,68,69 A comprehensive, placebo-controlled clinical trial would be useful to determine their efficacy. These pieces of evidence suggest that the acute phase of pain experience is less likely mediated by inflammation.…”

Section: Traditional Analgesicsmentioning

confidence: 99%

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Gain with no pain? Pain management in dermatological photodynamic therapy

et al. 2017

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Pain during photodynamic therapy (PDT) is the main limiting adverse effect in its use in dermatology. Given its multifactorial nature, we reviewed both intrinsic and extrinsic factors that are involved in PDT pain. We propose a threshold theory for pain experience in PDT: it correlates positively with fluence rate and dose below a certain threshold (rate of ~60 mW cm , dose of ~50 J cm ); when the threshold is surpassed, pain intensity saturates. Additionally, we carefully compared recent updates on pain management strategies and we suggest that cold-air analgesia and low-irradiance light sources (such as variable pulsed light and daylight PDT) represent the current best analgesic options. Finally, we discuss the possible mechanisms of pain experience during PDT. Reactive oxygen species, transient receptor potential channels and inflammatory responses are key mediators in pain. Further investigation into these pathways should help with the development of more effective analgesic strategies. Taking these points together, for pain management in PDT, an individualized plan of analgesia is possible.

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Section: Pain Managementsupporting

confidence: 83%

Section: Pain Managementsupporting

confidence: 64%

Section: Pain Managementmentioning

confidence: 99%

Section: Traditional Analgesicsmentioning

confidence: 99%

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Gain with no pain? Pain management in dermatological photodynamic therapy

et al. 2017

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“…Surface fluorescence with a Wood's lamp can help delineate lesions and identify persistent disease. Treatment can be painful but can be managed with cold‐air analgesia or nerve blocks . Erythema and crusting often occur but can be reduced by the use of plaster or physical sunscreens …”

Section: Treatmentmentioning

confidence: 99%

British Association of Dermatologists’ guidelines for the care of patients with actinic keratosis 2017

Berker¹,

et al. 2017

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Methadone enhances the effectiveness of 5‐aminolevulinic acid‐based photodynamic therapy for squamous cell carcinoma and glioblastoma in vitro

Shi

Büchner

Pohla

et al. 2019

Journal of Biophotonics

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Although having shown promising clinical outcomes, the effectiveness of 5‐aminolevulinic acid‐based photodynamic therapy (ALA‐PDT) for squamous cell carcinoma (SCC) and glioblastoma remains to be improved. The analgesic drug methadone is able to sensitize various tumors to chemotherapy. In this in vitro study, the influence of methadone to the effectiveness of ALA‐PDT for SCC (FADU) and glioblastoma (A172) was investigated on the protoporphyrin IX (PpIX) fluorescence, survival rates, apoptosis, and cell cycle phase, each with or without the presence of methadone. The production of PpIX was increased by methadone in FADU cells while it was decreased in A172 cells. The survival rates of both cell lines treated by ALA‐PDT were significantly reduced by the combination with methadone (P < .05). Methadone also significantly increased the percentage of apoptotic cells and improved the effect of ALA‐PDT on the cell cycle phase arrest in the G0/G1 phase (P < .05). This study demonstrates the potential of methadone to influence the cytotoxic effect of ALA‐PDT for both SCC and glioblastoma cell lines.

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Comparing cold-air analgesia, systemically administered analgesia and scalp nerve blocks for pain management during photodynamic therapy for actinic keratosis of the scalp presenting as field cancerization: a randomized controlled trial

Abstract: Scalp nerve blocks provide an effective method for pain management during PDT for patients with extensive AK.

Cited by 26 publications

References 37 publications

Gain with no pain? Pain management in dermatological photodynamic therapy

Gain with no pain? Pain management in dermatological photodynamic therapy

British Association of Dermatologists’ guidelines for the care of patients with actinic keratosis 2017

Methadone enhances the effectiveness of 5‐aminolevulinic acid‐based photodynamic therapy for squamous cell carcinoma and glioblastoma in vitro

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