title: Pain associated with aminolevulinic acid-photodynamic therapy of skin disease.
abstract: BACKGROUND
  Pain during topical aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) limits the use of this treatment of skin diseases.
  
  
  OBJECTIVE
  We sought to summarize the effectiveness of interventions to reduce ALA-PDT-related pain, and to explore factors contributing to pain induction.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Pain perception differs widely between patients and can contribute to variability in the reported results.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Christine B
authors.initials: CB
authors.lastname: Warren
authors.forename: Laszlo J
authors.initials: LJ
authors.lastname: Karai
authors.forename: Allison
authors.initials: A
authors.lastname: Vidimos
authors.forename: Edward V
authors.initials: EV
authors.lastname: Maytin
mesh_terms: D000279:Administration, Cutaneous; D000622:Aminolevulinic Acid / Q000008:administration & dosage / Q000009:adverse effects*; D000698:Analgesia / Q000379:methods; D006801:Humans; D010146:Pain / Q000139:chemically induced / Q000209:etiology*; D059408:Pain Management; D010778:Photochemotherapy / Q000009:adverse effects*; D017319:Photosensitizing Agents / Q000008:administration & dosage / Q000009:adverse effects*; D011879:Radiotherapy Dosage
chemical_list: D017319:Photosensitizing Agents; D000622:Aminolevulinic Acid