Pain and Photodynamic Therapy

Abstract

Background: Photodynamic therapy (PDT) is increasingly used in the treatment of various skin diseases. The main adverse effect in PDT treatment is pain. Each lesion is generally treated twice, and clinical experience suggests that the 2nd treatment causes more pain than the 1st and thus becomes a therapy-limiting factor. Objectives: To investigate the intrapatient variation in the experience of pain, between 1st and 2nd PDT treatments. Methods: We registered patients treated with PDT by using a mechanical visual analogue scale (VAS). Patients were tested immediately after the 1st and 2nd PDT treatments. Intrapatient comparison was made comparing 1st and 2nd treatments. Results: A total of 38 patients were included. The median VAS score increased significantly according to the Wilcoxon matched-pairs signed-ranks test (p < 0.02) from 4 after the 1st PDT (range 0–8) to 4.75 (range 1–10) after the 2nd PDT treatment. The VAS score of pain was increased in the 2nd treatment for 21 patients, remained unchanged in 6 patients and was reduced in 11 patients who reported less pain after the 2nd treatment. Patients who scored low (VAS <5) after the 1st treatment experienced an increase in mean VAS score of 1.4 at the 2nd PDT treatment. In contrast, subjects with a high VAS score (>5) after the 1st PDT had a mean decrease in the VAS score of 0.26 at the 2nd PDT treatment. The difference (p = 0.005) suggests that the pain at the 1st PDT treatment may be predictive of future pain. Conclusion: The 2nd treatment of PDT was significantly more painful than the 1st, although some patients experienced reduced pain on the 2nd treatment. The pain experienced at the 1st PDT treatment may be predictive of the pain at subsequent treatments.

Photodynamic Therapy of Necrobiosis Lipoidica – A Multicenter Study of 18 Patients

“…Even though it was not observed in a vast number of our patients, a few did report very strong discomfort during illumination. It has been shown previously that the intensity of pain significantly increased at the second PDT treatment [14]. We also observed an increase in pain with the number of PDT sessions.…”

Photodynamic Therapy as an Alternative Treatment for Cutaneous Sarcoidosis

“…In summary, both types of lamps achieved comparable results in terms of efficacy, while fewer side effects such as local pain were observed with wIRA. Furthermore, studies revealed that the intensity of pain during PDT correlated more often with the size of the treated area than with the dose of light used [12, 13]. We conclude that the novel treatment regime for cutaneous sarcoidosis introduced here clearly shows that methyl aminolevulinate (Metvix) as well as wIRA represent useful alternative therapeutic tools to optimize treatment of cutaneous sarcoidosis with PDT.…”

Generalized Granuloma Annulare Treated with Methylaminolevulinate Photodynamic Therapy

“…Our patients experienced mild pain during the irradiation. The reason for this moderate sensation might be the sites of the treated lesions, known to be generally associated with less pain (arms, limbs or trunk compared with the face or scalp) and likely the smaller amount of cells in the GA lesions that actively metabolized MAL into the photo-active protoporphyrin IX compared with actinic keratosis or basal cell carcinoma [12, 13]. …”