Important Factors for Pain during Photodynamic Therapy for Actinic Keratosis

Abstract

Photodynamic therapy (PDT) is an efficient treatment for actinic keratosis. A common problem, however, is pain. The aim of this study was to investigate pain during PDT for actinic keratosis. The possibility of using capsaicin cream for pain relief was also assessed. Pain was investigated during aminolaevulinic acid PDT in 91 patients. Size, redness, scaling and induration of the lesions were recorded. Maximum pain during treatment was registered, using a visual analogue scale (0-10). The pain-reducing efficacy of capsaicin was tested in a pilot study in six patients (10 lesions). These patients were pre-treated with capsaicin cream for one week before commencing PDT. Pain was found to be normally distributed around a mean value of visual analogue scale 4.6. Larger lesions gave more pain (p=0.001). The redness of the actinic lesions was found to be related to PDT-induced pain (p=0.01), the reduction of actinic area (p=0.007), and the cure rate (p=0.01). The redder the actinic area, the better the treatment outcome and the more pain experienced. Patients with the largest reduction in the actinic area experienced more pain (p=0.053). The most important factors for presence of pain seem to be the size and the redness of the lesion. No significant pain relief was experienced after pre-treatment with capsaicin.

Treatment with 5-Aminolaevulinic Acid Methylester Is Less Painful than Treatment with 5-Aminolaevulinic Acid Nanoemulsion in Topical Photodynamic Therapy for Actinic Keratosis

“…The interindividual difference in size might have biased the results by influencing the pain intensity [4,5]. However, other authors have already shown that the pain intensity is strongly dependent on the localization [2,4,6].…”

“…The main adverse effect in PDT treatment is pain. It has been shown that pain intensity depends on the localization [2,3], size [3,4,5], histological type [4], redness [5] and protoporphyrin IX (PpIX) fluorescence [6] of the treated lesion. Also different light sources [7,8,9], fluence rates [6] and photosensitizing agents [10,11] affect the pain additionally.…”

Correlation between Protoporphyrin IX Fluorescence Intensity, Photobleaching, Pain and Clinical Outcome of Actinic Keratosis Treated by Photodynamic Therapy

“…Considering the limited number of lesions in our report, the lesions could not be adequately subdivided in different anatomical zones. This may also degrade the correlation between the PpIX fluorescence and the pain since it has been reported that anatomical innervation differences may play an important role [37,57]. …”

“…Because pain is the main adverse effect for this treatment modality, a tablet of anti-inflammatory drug (Méfénacide®, 500 mg) was given to each patient 1 h before treatment [35,37,38,39,40]. Additionally the lesions were sprayed with cold water (approx.…”

Post procedural pain with photodynamic therapy is more severe than skin surgery

“…15 Pain can be more severe when a larger field is treated with PDT. 12 Kasche 16 demonstrated that pain during activation can be such that patients request discontinuation of treatment before reaching the required light dose has been reached. This was more likely if the patient was being treated with aminolevulonic acid (ALA) than if treated with methyl aminolevulinate (MAL).…”