Pain Management During Topical Photodynamic Therapy A Systematic Review And Meta-Analysis

Objectives: Topical photodynamic therapy(PDT) is a novel treatment, which is widely applied in dermatology for its advantages regarding safety and cosmetic effects. Topical photodynamic therapy is particularly suitable for large, multiple lesions, but pain was the severe drawback of topical PDT.The objective of this study was to assess the effects of multiple methods of pain management.Methods: The Embase, Pubmed, the Cochrane Library were searched on 20 December 2015. The pooled Weighted mean differences(WMD), Standard mean difference(SMD) and Odds ratio(OR) with 95% confidence intervals(CI) were calculated. We used the Review Manager software version 5.3 to analyze the data.Results: We identified 25 studies and 1491 patients; and 20 studies are available for quantitative analysis;and for 5 single studies just available for qualitative analysis.The results of meta-analysis indicated:MAL versus ALA, whether at the first session,the second session, and treatment of BD or s BCC during PDT, or at 3, 6,12, 16 minutes of illumination,PDT was less painful with MAL than with ALA( SMD-0.55 95%CI-0.82 to 0.28), The difference was shown at 12 minutes of irradiance, but not on other subgroups.During red light illumination, there were no difference between 100J/cm2 and 70J/cm2 light dose(WMD 0.31, 95%CI-0.31 to 0.93).Daylight photodynamic therapy(d PDT) versus conventional therapy(c PDT),d PDT was significantly less painful than c PDT(WMD-4.87 95%CI-5.34 to-4.40);During d PDT, there were no difference of pain scores whether exposure 1? hours or2? hours during PDT or 1 day after treatment(WMD 0.00, 95%CI-0.23 to 0.23).Cold air analgesia versus non-cold air analgesia, using cold air analgesia on the PDT treatment site is very effective at relieving pain(SMD-0.42,95%CI-0.60 to-0.23).Nerve block versus non-nerve block and Nerve blocks versus cold air analgesia showed that nerve block was more effective than others in pain control during PDT,(WMD-6.15,95%CI-6.72 to-5.57) and(WMD-5.18,95%CI-7.23 to-3.13)respectively.Plant derived spray versus placebo, plant derived spray is more effective than placebo(WMD-1.00, 95%CI-1.17 to-0.83); and cold water spray is more effective than non-cold water spray at the first stage or the second stage(WMD-1.30,95%CI-2.48 to-0.12).There was also no difference between cold water spray and cold water packs(WMD0.06,95%CI-1.12 to 1.25).Conclusions :MAL is less painful than ALA; and daylight photodynamic therapy is significantly less painful than c-PDT. Cold air analgesia, nerve blocks, plant derived spray, and cold water spray were all effective methods to control pain during PDT,but nerve block is more effective than cold air analgesia.