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Cited by 136Photodynamic Therapy Research StudiesNonmelanoma Skin Cancer StudiesDermatologic Treatments and Research

Pain associated with aminolevulinic acid-photodynamic therapy of skin disease

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Warren, Christine B., Karai, Laszlo J., Vidimos, Allison, Maytin, Edward V.·2009·Journal of the American Academy of Dermatology
DOI 10.1016/j.jaad.2009.03.048PMC PMC3529571
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Abstract

Background Pain during topical aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) limits the use of this treatment of skin diseases. Objective We sought to summarize the effectiveness of interventions to reduce ALA-PDT-related pain, and to explore factors contributing to pain induction. Methods A PubMed search was performed to identify all clinical PDT trials (2000-2008) that used ALA or methyl-ALA, enrolled at least 10 patients per trial, and used a semiquantitative pain scale. Results In all, 43 articles were identified for review. Pain intensity is associated with lesion size and location and can be severe for certain diagnoses, such as plaque-type psoriasis. Results are inconsistent for the correlation of pain with light source, wavelength of light, fluence rate, and total light dose. Cooling represents the best topical intervention. Limitations Pain perception differs widely between patients and can contribute to variability in the reported results. Conclusion Gamma-aminobutyric acid receptors, cold/menthol receptors (transient receptor potential cation channel, subfamily M, member 8), and vanilloid/capsaicin receptors (transient receptor potential cation channel, subfamily V, member 1) may be involved in pain perception during ALA-PDT and are therefore worthy of further investigation.

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  • Pain can be relieved with topical anesthetics, but only those that have neutral or acidic pH as ALA becomes unstable in alkaline environment.

    “Pain can be relieved with topical anesthetics, but only those that have neutral or acidic pH as ALA becomes unstable in alkaline environment [83].”

    From Aminolevulinic Acid (ALA) as a Prodrug in Photodynamic Therapy of Cancer (2011) · cites this paper as [83]

    In III. Pain Management, subsection “Topical Anesthesia” (page unavailable), the paper says most studies found no benefit from topical anesthetics for PDT pain; its Summary and Recommendations says traditional topical anesthetics “simply do not work.” It raises a possible interaction between analgesic pH and acidic ALA creams, but does not state that neutral or acidic anesthetics relieve pain or that ALA becomes unstable in alkaline conditions. (LLM, conf=0.88)

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  • Significant disadvantages of ALA-PDT include pain associated with treatment, limited depth of tumor penetration, as well as individual variations among patients that affect ALA absorption and pharmacokinetics that influence effective ALA concentrations in the treated area.

    “Nevertheless, significant disadvantages of ALA-PDT include pain associated with treatment [83], limited depth of tumor penetration [84,85], as well as individual variations among patients that affect ALA absorption and pharmacokinetics that influence effective ALA concentrations in the treated area [86].”

    From Aminolevulinic Acid (ALA) as a Prodrug in Photodynamic Therapy of Cancer (2011) · cites this paper as [83]

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  • Although ALA-PDT is generally well tolerated, some patients complain of stinging, burning, pricking, smarting and itching pain during PDT and several hours after irradiation.

    “Although ALA-PDT is generally well tolerated, some patients complain of stinging, burning, pricking, smarting and itching pain during PDT and several hours after irradiation.”

    From Aminolevulinic Acid (ALA) as a Prodrug in Photodynamic Therapy of Cancer (2011) · cites this paper as [83]

    The Introduction (page unavailable) says burning, stinging and prickling commonly occur during illumination. Section II.iii (page unavailable) reports that pain after ALA-PDT for warts can persist up to 48 hours, supporting post-treatment pain in that condition. The copy does not describe smarting or itching as ALA-PDT pain symptoms; it mentions itching as a side effect of capsaicin cream used in a pain-relief study. (LLM, conf=0.85)

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Cited by

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Authors
Warren, C. B., Karai, L. J., Vidimos, A., & Maytin, E. V.
Affiliations
  • Cleveland Clinic Lerner College of Medicine (US)
  • Cleveland Clinic (US)
Corresponding author
Maytin, Edward V.
ORCID
Venue
Journal of the American Academy of Dermatology
Publisher
Elsevier BV
Published
2009-12
Volume
61
Issue
6
Pages
1033-1043
ISSN
0190-9622 (ISSN-L)
DOI
10.1016/j.jaad.2009.03.048
PMC
PMC3529571
OpenAlex
W1971453398
Cited by
136
References
3
Citations by year
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FWCI
1.69
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American Academy of Dermatology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Cancer Institute (CA84203, P01CA084203)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Photodynamic Therapy Research Studies
  • Health Sciences › Medicine › Epidemiology › Nonmelanoma Skin Cancer Studies
  • Health Sciences › Medicine › Dermatology › Dermatologic Treatments and Research
Keywords
5-aminolevulinic acid, photodynamic therapy, topical analgesia, cooling, psoriasis, pain perception, TRPM8, TRPV1, GABA receptors, skin diseases
MeSH terms
Administration, Cutaneous, Aminolevulinic Acid, Analgesia, Humans, Pain, Photochemotherapy, Radiotherapy Dosage, Photosensitizing Agents, Pain Management

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