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Nerve blocks provide effective pain relief during topical photodynamic therapy for extensive facial actinic keratoses


  • Conflict of interest: A.-M. Wennberg has taken part in clinical trials with Galderma, Photocure, 3 M and Fujisawa, and has received fees for giving lectures from Galderma, Photocure, 3 M, Fujisawa and Schering-Plough. The other authors have no conflict of interest to declare.

Dr John Paoli, MD, Department of Dermatology, Sahlgrenska University Hospital, 413 45 Göteborg, Sweden.


Background.  Photodynamic therapy (PDT) is a first-line therapeutic option for skin areas with multiple actinic keratoses (AKs). Its main drawback is the pain perceived during the irradiative phase, especially when treating field cancerization in the facial area. Effective pain-relieving strategies are needed.

Aim.  To determine the effectiveness of peripheral nerve blocks in achieving pain relief during PDT for extensive facial AKs.

Methods.  In total, 16 patients with symmetrically distributed facial AKs, mainly on the forehead, were enrolled in the study. Nerve blocks were applied unilaterally, and the nonanaesthetized side of the treatment area served as control. Maximum pain during PDT was evaluated using a visual analogue scale (VAS). Pain experienced after PDT was evaluated by telephone interview within 2 weeks of treatment. Cure rates were assessed at follow-up at least 4 weeks after treatment.

Results.  Pain was significantly reduced on the anaesthetized side (P < 10−8). The mean ± SEM VAS score on the blocked side of the face was 1.3 ± 0.3 compared with 7.5 ± 0.5 on the nonanaesthetized side. Pain relief persisted 1–2 h after PDT. The nerve block was generally not experienced as painful (14/16 patients). Almost all patients (15/16 patients) would like to receive nerve blocks bilaterally if future PDT were needed. Excellent clinical results were observed in all patients after 4–20 weeks.

Conclusion.  Nerve blocks provide efficient pain relief during PDT when treating patients with field cancerization of the forehead. Nerve blocks were not found to affect the clinical outcome of PDT, and were generally well tolerated by the patients.

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