Gain with no pain? Pain management in dermatological photodynamic therapy

Abstract

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 proposed a threshold theory for pain experience in PDT: it positively correlates with fluence rate and dose below certain threshold (rate of ~60 mW/cm², dose of ~50 J/cm²); when threshold is surpassed, pain intensity no longer increases. Additionally, we carefully compared recent updates on pain management strategies and we suggested that cold air analgesia and low-irradiance light source (such as intense pulsed light and day-light PDTs) represent the current best analgesic options. Finally, we discussed the possible mechanisms of pain experience during PDT. Reactive oxygen species (ROS), TRP channels and inflammatory responses are key mediators in pain. Further investigation in these pathways can help with the development of more effective analgesic strategies. Taken together, for pain management in PDT, individualization plan of analgesia is highly yielded.

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