Pain Management in Dermatology (Part II)
Pain is a major clinical symptom in medicine. In the scope of Dermatology, pain occurs most commonly in the surgical setting, but it is also associated with a wide spectrum of chronic medical entities. On one hand, postsurgical pain is major cause of dissatisfaction and other negative postsurgical outcomes, such as pain chronification. On the other hand, chronic pain is a major cause of suffering and impaired quality of life in dermatological patients. Treatment is frequently challenging, further aggravated by the paucity of evidence-based recommendations for proper pain control in the dermatological care. This is the second and last part of a review on the general principles of acute peri-operative and chronic pain management in Dermatology. In this part, we’ll discuss the treatment of acute pain related with specific therapeutic procedures and the proper management of chronic and painful dermatological conditions.
Briggs M, Nelson EA, Martyn-St James M. Topical agents
or dressings for pain in venous leg ulcers. Cochrane Database
Syst Rev. 2012; 11 :CD001177.
Benedetto AV. A novel use of topical anesthetics to alleviate
the pain of cryotherapy. Skinmed. 2003; 2:307-8.
Gupta AK, Koren G, Shear NH. A double-blind, randomized,
placebo- controlled trial of eutectic lidocaine /
prilocaine cream 5% ( EMLA )@ for analgesia prior to
cryotherapy of warts in children and adults. Pediatr Dermatol.
Mishra S. Safe and less painful injection of triamcenolone
acetonide into a keloid e A technique. Br J Plast Surg.
Ono N. Pain-free intralesional injection of triamcinolone
for the treatment of keloid. Scand J Plast Reconstr Hand
Surg. 1999; 33:89-91.
Azad A, Sacks L. Painless steroid injections for hypertrophic
scars and keloids. Br J Plast Surg. 2003; 56:534.
Park KY, Lee Y, Hong JY, Chung WS. Vibration anesthesia
for pain reduction during intralesional steroid injection for
keloid treatment. Dermatol Surg. 2017; 43:724-7.
Ericson MB, Wennberg A. Review of photodynamic therapy
in actinic keratosis and basal cell carcinoma. Ther Clin
Risk Manag. 2008; 4:1-9.
Wan MT, Lin JY. Current evidence and applications of photodynamic
therapy in dermatology. Clin Cosmet Investig
Dermatol. 2014; 7:145-63.
Karrer S, Kohl E, Feise K, Hiepe-Wegener D, Lischner S,
Philipp-Dormston W, et al. Photodynamic therapy for skin
rejuvenation: review and summary of the literature – results
of a consensus conference of an expert group for
aesthetic photodynamic therapy. J Dtsch Dermatol Ges.
Uebelhoer NS, Dover JS. Photodynamic therapy for cosmetic
applications. Dermatol Ther. 2005; 18:242-52.
Virgili A, Osti F, Maranini C, Corazza M. Photodynamic
therapy: parameters predictive of pain. Br J Dermatol.
Waters A, Ibbotson S. Parameters associated with severe
pain during photodynamic therapy: results of a large Scottish
series. Br J Dermatol. 2011; 165:696-8.
Wang B, Shi L, Zhang YF, Zhou Q, Zheng J, Szeimies RM.
Gain with no pain? Pain management in dermatological
photodynamic therapy. Br J Dermatol. 2017; 177:656-
Arits A, van de Weert MM, Nelemans PJ, Kelleners-Smeets
NW. Pain during topical photodynamic therapy: uncomfortable
and unpredictable. J Eur Acad Dermatol Venereol.
Lindeburg KE, Brogaard HM, Jemec GB. Pain and photodynamic
therapy. Dermatology. 2007; 215:206-8.
Ang JM, Riaz IB, Kamal MU, Paragh G, Zeitouni NC. Photodynamic
therapy and pain: a systematic review. Photodiagnosis
Photodyn Ther. 2017; 19:308-44.
Berking C, Herzinger T, Flaig M, Brenner M, Borelli C,
Degitz K. The efficacy of photodynamic therapy in actinic
cheilitis of the lower lip: a prospective study of 15 patients.
Dermatol Surg. 2007; 33:825-30.
Manuscript A. Pain associated with aminolevulnic acid-
-photodynamic therapy of skin disease. J Am Acad Dermatol.
Greveling K, Prends E., Liu L, Van Doorn M. Non-invasive
anaesthetic methods for dermatological laser procedures
- a systematic review. J Eur Acad Dermatol Venereol.
Campos S. Manual de Anestesiologia Clínica.Lisboa:
Davis UC. Dermatology Online Journal UC Davis. Dermatol
Online J. 2013; 19:11.
Horvath B, Janse IC, Sibbald GR. Pain management in patients
with hidradenitis suppurativa. J Am Acad Dermatol.
Ryder SA, Stannard CF. Treatment of chronic pain: antidepressant,
antiepileptic and antiarrhythmic drugs. Contin
Educ Anaesth Crit Care Pain. 2005; 5: 18-21.
Basra MK, Shahrukh M. Burden of skin diseases. Expert
Rev Pharmacoecon Outcomes Res. 2009; 9:271-83.
Von Der Werth J, Jemec G. Morbidity in patients with hidradenitis
suppurativa. Br J Dermatol. 2001; 144:809-
Miner A. Concern regarding the safety of tumor necrosis
factor-alfa antagonists in pregnancy. J Am Acad Dermatol.
Gupta R. Post-herpetic neuralgia. Br J Anaesth. 2012;
Werner RN, Nikkels AF, Marinović B, Schäfer M, Czarnecka-
Operacz M, Agius AM, et al. European consensus-based
(S2k) Guideline on the Management of Herpes Zoster
- guided by the European Dermatology Forum (EDF) in
cooperation with the European Academy of Dermatology
and Venereology (EADV), Part 2: Treatment J Eur Acad
Dermatol Venereol. 2016; 31:20-9.
Gauthier A, Breuer J, Carrington D, Martin M, Remy V.
Epidemiology and cost of herpes zoster and post-herpetic
neuralgia in the United Kingdom. Epidemiol Infect. 2009;
Johnson RW, Rice AS. Clinical practice. Postherpetic neuralgia.
N Engl J Med. 2014;371: 1526-33.
Forbes HJ, Thomas SL, Smeeth L, Clayton T, Farmer R,
Bhaskaran K. A systematic review and meta-analysis
of risk factors for postherpetic neuralgia. Pain. 2016;
Sacks GM. Unmet need in the treatment of postherpetic
neuralgia. Am J Manag Care. 2013;19:3-10.
Haanpää M, Cruccu G, Nurmikko TJ, McBride WT, Docu
Axelarad A, et al. Capsaicin 8% patch versus oral pregabalin
in patients with peripheral neuropathic pain. Eur J
Pain. 2016; 20:316-28.
GERMI, Sociedade Portuguesa de Medicina Interna. Vacinação
da população idosa em Portugal: Recomendações
Europeias. [consultado jun 2017] Disponível em: http://
Han Y, Zhang J, Chen N, He L, Zhou M, Zhu C. Corticosteroids
for preventing postherpetic neuralgia Cochrane
Database Syst Rev. 2013;3:CD005582.
Parra S, Lacouture P, Giles H. Chronic leg ulcer pain – a
need for effective topical analgesia. J Pain. 2015; 17:S13-
Green J, Jester R, Mckinley R, Pooler A, Care S. The impact
of chronic venous leg ulcers: a systematic review. J Wound
Care. 2013; 23:601-12.
Gonza RV. Quality of life in people with venous leg ulcers:
an integrative review. J Adv Nurs. 2011; 67:926-44.
Beiteke U, Bigge S, Reichenberger C, Gralow I. Pain and
pain management in dermatology. J Ger Soc Dermatol.2015:967-87.
Bastami S, Frödin T, Ahlner J, Uppugunduri S. Topical
morphine gel in the treatment of painful leg ulcers , a double-
blind , placebo-controlled clinical trial: a pilot study.
Int Wound J. 2012; 9:419-27.
Renner R, Seikowski K, Simon JC. Association of pain
level, health and wound status in patients with chronic leg
ulcers. Acta Derm Venereol. 2014; 94:50-3.
Kahle B, Hermanns H, Gallenkemper G. Evidence-based
treatment of chronic leg ulcers. Dtsch Arztebl Int. 2011;
Bigliardi-qi M, Sumanovski LT, Büchner S, Rufli T, Bigliardi
PL. Mu-opiate receptor and beta-endorphin expression in
nerve endings and keratinocytes in human skin. Dermatology.
Vernassiere C, Cornet C, Trechot P, Alla F, Truchetet F, Cuny
JF, et al. Study to determine the efficacy of topical morphine
on painful chronic skin ulcers. J Wound Care. 2005;1
Jansen MM, van der Horst JC, van der Valk PG, Kuks PF,
Zylicz Z, van Sorge AA. Pain-relieving properties of topically
applied morphine on arterial leg ulcers: a pilot study.
J Wound Care. 2004; 18:306-11.
Marcio L, Martin M, Barbosa LR. Hyperbaric oxygen therapy
as an adjuvant treatment for. An Bas Dermatol. 2011;
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