Pain in photodynamic therapy:prevention and treatment

局部光动力疗法是一种高效、安全的治疗方法，目前广泛治疗光线性角化病、基底细胞癌、鲍恩病、尖锐湿疣等多种皮肤病。光动力疗法治疗过程中主要不良反应是局部疼痛，主要表现为局限性、浅表性灼烧感或针刺痛，患者有时因难以忍受治疗过程中的疼痛而中断或终止治疗。目前疼痛的机制尚未清楚，其主要影响因素包括光敏剂类型，病变的部位、种类、大小，光照能量，光源类型，荧光强度等。临床上主要止痛方案包括口服止痛药、冷风、麻醉止痛，减少照射强度，两部照射法等。在临床工作中，根据具体情况选择可行的止痛方案对减轻患者光动力治疗中的局部疼痛尤为重要。Topical photodynamic therapy, a highly effective and safe treatment, now is widely used to treat many skin diseases, including actinic keratosis, basal cell carcinoma, Bowen′s disease, condyloma acuminatum, and so on. The major drawback of photodynamic therapy is pain during the treatment, which is usually described as a topical, superficial burning or prickling sensation. Sometimes, patients have to interrupt or terminate the treatment because of pain intolerance. The mechanisms of pain have not yet been fully clarified, and its main influential factors include the type of photosensitizers, lesional location, type and size, light energy, type of light sources, fluorescence intensity, etc. In clinic, pain is mainly managed by oral analgesics, cold air, narcotic analgesics, reduction in radiation intensity, two?step irradiation, and so on. In clinical practice, choosing a feasible and personalized strategy is very important for relief of pain during topical photodynamic therapy.125-274