Warren Christine B, Karai Laszlo J, Vidimos Allison, Maytin Edward V
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Am Acad Dermatol. 2009 Dec;61(6):1033-43. doi: 10.1016/j.jaad.2009.03.048.
Pain during topical aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) limits the use of this treatment of skin diseases.
We sought to summarize the effectiveness of interventions to reduce ALA-PDT-related pain, and to explore factors contributing to pain induction.
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.
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.
Pain perception differs widely between patients and can contribute to variability in the reported results.
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.
局部应用氨基乙酰丙酸（ALA）介导的光动力疗法（PDT）过程中的疼痛限制了该疗法在皮肤病治疗中的应用。
我们试图总结减少ALA-PDT相关疼痛的干预措施的有效性，并探讨导致疼痛产生的因素。
通过PubMed检索，以确定所有使用ALA或甲基-ALA的临床PDT试验（2000年至2008年），每个试验至少纳入10例患者，并使用半定量疼痛量表。
共识别出43篇文章进行综述。疼痛强度与皮损大小和部位相关，对于某些诊断（如斑块型银屑病）可能较为严重。关于疼痛与光源、光波长、能量密度率和总光剂量之间的相关性，结果并不一致。冷却代表最佳的局部干预措施。
患者之间的疼痛感知差异很大，这可能导致报告结果的变异性。
γ-氨基丁酸受体、冷/薄荷醇受体（瞬时受体电位阳离子通道M亚家族成员8）和香草酸/辣椒素受体（瞬时受体电位阳离子通道V亚家族成员1）可能参与ALA-PDT过程中的疼痛感知，因此值得进一步研究。
