Efficacy Evaluation Of Pain Relief Regimens On Patients With Condyloma Acuminata Treated By Topical ALA Photodynamic Therapy

Background: Photodynamic therapy(PDT)is an effective treatment for Condyloma Acuminatum.It has been widely used in condyloma acuminatum in recent years,which has significantly reduced the recurrence rate of CA.Although the therapeutic effect of PDT is considerable,the side effects can not be ignored.In clinical practice,many patients interrupt or even terminate the process because of the unbearable pain during the treatment.The poor compliance of patients leads to inadequate PDT treatment cycle and wastes treatment resources.Therefore,the study of photodynamic pain management strategies and mechanisms is of great clinical significance.There are many factors affecting the pain of PDT,and so are great individual differences.The known pain management strategies at home and abroad include anesthesia analgesics,oral analgesics,two-step irradiation,interruption irradiation,transcutaneous nerve electrical stimulation,hypnosis,music therapy and so on.All kinds of analgesic schemes have their advantages and disadvantages.However,up to now,there is no effective way to alleviate pain mediated by PDT in CA without affecting the therapeutic effect.This paper mainly discussed the effects of ibuprofen,cold air,two-step irradiation and its combined analgesic regimen on pain induced by photodynamic therapy on CA.And to provide a safe and effective pain management scheme for clinical ALA-PDT treatment of CA.Methods: From May 2018 to November 2018,131 patients aged 16 to 60 were enrolled in the outpatient department of Dermatology and venereology,Shenzhen Hospital,Peking University.Among them,78 were male and 53 were female.The total number of treatments was 393.The treatment site was only located in the male coronal sulcus,prepuce,scrotum and pudendum,and the female of pudendum,vaginal orifice,urethral orifice and labia minor.All patients received 3 treatments with a treatment interval of 7-14 days and a total of 393 treatments.During treatment,patients were randomized according to different analgesic regimens.Blank control group(group A)received no analgesic treatment;group B,oral ibuprofen sustained release capsule;group C,treating with cold air;Group D,two-step irradiation;B + C group,oral ibuprofen sustained release capsule + cold air,and B + D group,oral ibuprofen sustained release capsule + two-step irradiation.There were total of six treatment methods.Visual Analogue Scale was used to observe the pain score during PDT treatment,and then recorded VAS-5,VAS-end and VAS-end30.SPSS24.0 was used for statistical analysis.Variance analysis was used for data comparison among groups.S-N-K method was used for comparison among groups.P < 0.05 indicated that there was significant difference.Results: A total of 131 patients were enrolled,including 78 males and 53 females.All patients completed the treatment.The average pain score was 4.02±2.06.The average VAS5 score was 5.07±1.88.The average VAS-end score was 4.27±1.88,and the average VAS-end 30 score was 2.71±1.68.When considering VAS-5 score,the mean value of blank control group was higher than that of C,B+C,B+D group,with statistical significance(P < 0.05).The mean value of D group was higher than that of C,B+D group,with statistical significance(P < 0.05).The mean value of B+C group was higher than that of C,B+D group,with statistical significance(P < 0.05);and the mean value of B+C group was higher than that of B+D group,with statistical significance(P < 0.05).When considering VAS-end score,VAS-end score,the mean value of B+D group was lower than that of the other five groups,and the difference was significant(P < 0.05).When considering VAS-end30 score,the mean value of group B + C was higher than that of group C,D and B + D,with statistical significance(P < 0.05).Group B was higher than that of group C and B + D,with statistical significance(P < 0.05).Group A was higher than that of group B and B + D,with statistical significance(P < 0.05).Group D was higher than that of group B + D,with statistical significance(P < 0.05).There was no significant difference in VAS5,VASend and VAS30 among different treatment times(P > 0.05).There was no significant difference in VAS5,VASend and VAS30 among different clearance methods(P > 0.05).Conclusion: During PDT treatment,moderate pain occurred 5 minutes before treatment and 30 minutes after treatment,and mild pain occurred 30 minutes after treatment.12.7% of patients complained of severe pain,43.9% of patients complained of moderate pain and 43.4% of patients complained of mild pain.Oral ibuprofen,cold air and two-stage irradiation can improve pain to a certain extent.The combined use of the two analgesic schemes is better.Oral ibuprofen can improve the pain at the end of treatment and 30 minutes after treatment.Blowing cold wind can significantly improve the pain at the end of treatment for 30 minutes.Two-step irradiation mainly relieves the pain when light starts 5 minutes and 30 minutes after treatment.The analgesic effect of ibuprofen combined with two-step irradiation group is more significant than other groups when light starts 5 minutes and at the end of treatment and 30 minutes after treatment.PDT treatment times,wart clearance methods and wart number did not significantly improve the pain associated with photodynamic therapy.