Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University, School of Medicine, Shanghai, China; Dermatology, Clinical Medical of Yangzhou University, Yangzhou, Jiangsu, China.
Institute of Photomedicine, Shanghai Skin Disease Hospital, Tongji University, School of Medicine, Shanghai, China.
Photodiagnosis Photodyn Ther. 2019 Jun;26:73-78. doi: 10.1016/j.pdpdt.2019.03.001. Epub 2019 Mar 2.
To date, it has been reported that the intrinsic factors(lesions location, lesions area, disease tynpes) and extrinsic factors(fluence rate) contribute to the pain during 5-aminolevulinic acid photodynamic therapy (ALA-PDT). But there are few studies on pain during ALA-PDT and lack of sufficient clinical evidence related to the pain intensity.
To investigate pain intensity and its relative factors during ALA-PDT and to provide clinical implication.
The pain numeric rating scale (PNRS) score was used to evaluate the patients' pain intensity at different times during ALA-PDT irradiation from 0 to 10 min during treatment. Gender, age, lesions location, lesions area, ALA concentration and fluence rate were recored.
The trial enrolled 274 patients in total, including 118 acne patients (in face), 30 actinic keratosis(AK)patients(in face), 126 Condylomatata acuminate patients(in genitalia). The average pain score in PDT was highest in the patients with actinic keratosis(7.3 ± 0.7), and that of condylomata acuminata was the lowest (4.5 ± 1.1) (p < 0.05). The highest pain score in patients with AK, acne and condylomata acuminata was 8, 6 and 6 respectively which occurred at 4 min, 4 min and 6 min respectively. The pain score of males was higher compared with females in all of the three diseases (p < 0.05). The pain score of facial diseases (5.6 ± 1.2) was higher than that of the genitalia (4.5 ± 1.1) (p < 0.05). The lesions area was positively correlated with the pain score (p < 0.05). In facial diseases, the pain score of patients with high fluence rate (7.3 ± 0.7) was higher than patients with low fluence rate (5.1 ± 0.9) (p < 0.05).
Intrinsic and extrinsic factors both correlate with pain during PDT. Intrinsic factors are difficult to change, so extrinsic factors are the key point to control. We can reduce the fluence rate and extend the treatment time, relieving pain intensity while still ensuring equivalent efficacy.
迄今为止，已有研究报道，内在因素（病变位置、病变面积、疾病类型）和外在因素（能量密度）与 5-氨基酮戊酸光动力疗法（ALA-PDT）期间的疼痛有关。但是，关于 ALA-PDT 期间疼痛的研究较少，且缺乏与疼痛强度相关的充分临床证据。
探讨 ALA-PDT 期间疼痛强度及其相关因素，为临床治疗提供参考。
在治疗过程中，于 0 至 10 分钟期间，采用疼痛数字评分量表（PNRS）评估 ALA-PDT 照射过程中患者不同时间的疼痛强度。记录患者的性别、年龄、病变位置、病变面积、ALA 浓度和能量密度。
本试验共纳入 274 例患者，其中痤疮患者 118 例（面部），光化性角化病患者 30 例（面部），尖锐湿疣患者 126 例（生殖器）。光化性角化病患者的 PDT 平均疼痛评分最高（7.3±0.7），尖锐湿疣患者的评分最低（4.5±1.1）（p<0.05）。光化性角化病、痤疮和尖锐湿疣患者的最高疼痛评分分别为 8、6 和 6，分别发生在 4 分钟、4 分钟和 6 分钟。三种疾病中，男性的疼痛评分均高于女性（p<0.05）。面部疾病的疼痛评分（5.6±1.2）高于生殖器疾病（4.5±1.1）（p<0.05）。病变面积与疼痛评分呈正相关（p<0.05）。在面部疾病中，高能量密度（7.3±0.7）患者的疼痛评分高于低能量密度（5.1±0.9）患者（p<0.05）。
内在和外在因素均与 PDT 期间的疼痛相关。内在因素难以改变，因此外在因素是控制疼痛的关键。我们可以降低能量密度并延长治疗时间，在确保等效疗效的同时减轻疼痛强度。
