Pain relief and other practical issues in photodynamic therapy

Ann-Marie Wennberg
Department of Dermatology, Sahlgrenska University Hospital, Göteborg, Sweden 

We have been using photodynamic therapy (PDT) at the Department of Dermatology, Sahlgrenska University Hospital in Göteborg since the 1990s, so we have gained considerable experience with the technique.

Sometimes patients experience pain with PDT. Such pain typically involves a burning, stinging and prickling sensation during illumination, which arises quickly (within a few seconds to a minute after commencing illumination), peaks quickly and then levels off. In some patients pain persist for a longer duration (up to 24 h), and there have been a few rare cases where pain has lasted for several days after treatment.

The mechanism of this pain has not been fully elucidated; with aminolevulinic acid (ALA) PDT, the gamma amino butyric acid (GABA) receptor system may be involved, because ALA is transported into peripheral nerve endings by GABA receptors. This can result in fibre stimulation and pain. Other mechanisms may also be involved. 

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