Photodynamic therapy – Aspects of pain management

Fink, Christine; Enk, Alexander; Gholam, Patrick

doi:10.1111/ddg.12546

Cited by 38 publications

(43 citation statements)

References 44 publications

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“…70 More specifically, anaesthesia should be given to trigeminal branches of the supraorbitalis, supratrochlearis, infraorbitalis and mentalis. [70][71][72] Similar results were achieved in another three independent studies, with DVAS ranging from À4Á2 to À6Á3. 69,71,73 Compared with other pain management methods such as cold air and oral analgesia, nerve block is significantly more effective.…”

Section: Nerve Blocksupporting

confidence: 86%

“…Pain was significantly reduced in the anaesthetic side (the VAS score decreased from 7·5 ± 0·5 to 1·3 ± 0·3; ΔVAS = −6·2) . 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 .…”

Section: Pain Managementsupporting

confidence: 70%

“…75 Numerous researchers have proved that CAG significantly reduces pain intensity, duration and erythema, as well as increasing patient satisfaction in PDT. 48,72,[75][76][77][78] The potential mechanisms of CAG in pain management include (i) vasoconstriction, which is mediated by a sympathetic noradrenergic system that responds to cold stimuli; 79 (ii) reduction in tissue metabolism and (iii) decreased firing of nociceptive neurons: Thermotransient receptor potential (thermo-TRP) channels are the main mediators that sense different temperatures and alter the activity of nociceptive neurons.…”

Section: Cold Airmentioning

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: Nerve Blocksupporting

confidence: 86%

Section: Pain Managementsupporting

confidence: 70%

Section: Cold Airmentioning

confidence: 99%

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Gain with no pain? Pain management in dermatological photodynamic therapy

et al. 2017

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“…However, strategies to circumvent, reduce or cope with PDT-induced pain are of importance for the dermatological community [87][88]91]. During recent years, modified PDT protocols using natural or simulated daylight have been developed which can be implemented to manage pain in clinical routine.…”

Section: Clinical Safetymentioning

confidence: 99%

A review of BF-200 ALA for the photodynamic treatment of mild-to-moderate actinic keratosis

Reinhold¹

2017

Future Oncol.

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BF-200 ALA is a combination of a nanoscale-lipid vesicle formulation and the prodrug 5-aminolevulinic acid (5-ALA). The nanoemulsion stabilizes the prodrug and enhances its penetration through the stratum corneum. It has shown excellent therapeutic results in both lesion and field-directed photodynamic therapy of actinic keratosis (AK). AK is an early form of epidermal neoplasia and a precursor of invasive cutaneous squamous cell carcinoma. It is characterized by the combination of visible neoplastic lesions and surrounding tissue also harboring tumorigenic UV-induced mutations: a concept called field cancerization. A selective, field-directed treatment is ideal to meet the requirements of field change. Here, we review the clinical data on BF-200 ALA for AK along with a summary of molecular mechanisms and future perspectives. Actinic keratosis (AK), also known as solar keratosis, is caused by chronic exposure to sunlight or other ultraviolet light sources [1,2] and may progress to invasive squamous cell carcinoma (SCC) [3]. It is the most common lesion with malignant potential to arise on the skin. AK is mostly seen in Caucasians in skin areas that have extensive sun exposure throughout their lives [4]. Epidemiological data show a high occurrence rate of AK. Regions with higher ultraviolet exposure have a higher prevalence of AK. For the USA, the prevalence was estimated to range from 11 to 26%, while in Australia it ranged from 40 to 60%. In Europe, a prevalence of 15% in men and 6% in women has been documented [5]. Over the age of 70 years, 34% of men and 18% of women were found to have actinic keratotic lesions [6]. Next to fair skin type, an advanced age and lifelong sun exposure immunosuppression/-deficiency plays another important risk factor [5].Mostly, AK develops slowly and early in the disease process, they may disappear only to reappear later. Recurrence of the disease may include partial elimination of the initial lesion, subclinical lesion progression to visible status, or development of new lesions [7]. On top of this, an AK may progress to invasive SCC, the second-most common form of skin cancer [8,9]. The actual percentage of progress to invasive SCC remains unknown, and estimates vary from 5 to 20% within 10 to 25 years with reported annual transformation rates varying greatly from as low as 0.25% to as high as 16% [10]. The regression rate for a single untreated lesion is 15 to 63% after a year; recurrence rates range from 15 to 53% [11]. In general patients develop multiple AKs in one area and predicting which course each individual lesion will follow is impossible. Nonetheless, AK lesions are reliable markers for patients who are most predisposed to developing invasive SCC [4,[12][13].AK lesions typically appear in areas most frequently exposed to the sun such as the face, back of the hands, or bald scalp; 75% of lesions are found on the head, neck and forearms [14]. The lesions vary in appearance as well as size and can include erythematous scaly macules, rough pigmented patches and hyperker...

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“…Topical photodynamic therapy (PDT) is strongly recommended in patients with field cancerization or confluent AK lesions, since untreated lesions can progress into invasive SCC . PDT is rated as a good treatment option in recent guidelines; it has high efficacy and provides excellent cosmetic outcomes . PDT is based on the activation by visible light of a photosensitizing agent that interacts with oxygen to generate a cytotoxic product.…”

Section: Introductionmentioning

confidence: 99%