Two-step Irradiance Protocol And Preemptive Analgesics For Pain Control During Topical5-aminolevulinic Acid-Photodynamic Therapy Of Condyloma Acuminatum In Chinese Patients:a Prospective Study

Background and objective:Photodynamic therapy with5-aminolevulinic acid (ALA-PDT) offers promising results for the treatment of condyloma acuminatum. However, patients have to dwell with pain to benefit from this otherwise effective and safe "off-label" treatment modality. Several techniques have been explored to control ALA-PDT-induced pain, but the desperate search for a universally-accepted method is still ongoing.This study compares the two-step irradiance approach with single-dose administration of100mg tramadol sustained-release tablets for pain induced by ALA-PDT of condyloma acuminatum in Chinese patients.Patients and methods:Adult Chinese patients with condyloma acuminatum were enrolled in a randomized comparative study. Pain levels were compared using the Numeric Rating Scale (NRS) at pre-defined assessment points during and after irradiation.Results:The pain was dominated by characteristics such as burning and pricking and was almost always local and superficial.During irradiation:The median pain scores were lower in the two-step irradiance group at1minute (U=621.5, p=0.002) but higher at20minutes (U=585.5, p=0.002). The median pain scores between the two groups did not differ significantly at other assessment points. The pain was moderate in both groups and peaked earlier in the analgesics group (median:5minutes) but later in the two-step irradiance group (median:15minutes).After irradiation:The pain was generally mild. The median pain scores were equal at each assessment point, except at3hours where the median was lower in the analgesics group (1.0) as compared with the two-step irradiance group (2.0)(U=725.0,p=0.056).Conclusions:Pain in the two-step irradiance protocol is irradiance-dependent. The two-step irradiance approach produces significant benefits over analgesics during the initial stages of therapy but analgesics offer significant benefits thereafter. There are potential benefits of combining the two approaches in minimizing ALA-PDT-induced pain. Background and objective:The excellent clinical outcomes of5-aminolevulinic acid-photodynamic therapy (ALA-PDT) are overshadowed by pain reported during irradiation. Pain-free ALA-PDT is still difficult to achieve due to lack of an effective method of pain control. Delivery of light dose at initial lower irradiances followed by higher irradiances has been shown to be effective in minimizing pain. We recently compared this approach, called the two-step irradiance protocol, with preemptive analgesics (tramadol) for pain control during ALA-PDT of condyloma acuminatum (CA) and found that it offered significant benefits during the initial stages of therapy while analgesics offered significant benefits at later stages. This study evaluated the efficacy of a combination of preemptive analgesics (tramadol) and the two-step irradiance protocol for pain control during ALA-PDT of CA.Patients and methods:41Chinese patients with CA were enrolled into the study between September2013and February2014. The Numeric Rating Scale (NRS) was used to assess pain. The ability of the combined approach to keep the pain at clinically-acceptable levels (NRS<4) during and after treatment was also assessed.Results:The approach exhibited a combination of the characteristics of the separate approaches. The proportion of patients with NRS scores below4in the combined approach and the separate approaches did not differ significantly. Location and size of the lesions, as well as patient’s gender and age did not affect pain levels.Conclusions:The initial results are not conclusive enough to suggest the method to be adopted widely by dermatologic clinics. Background and objective:Patients with condylomata acuminata (CA), and their partners, are routinely counseled regarding lifestyle changes and disease transmission. However, feedback reports on how they implement the counseling messages are few. This study investigates the post-treatment sexual behavior of Chinese patients with CA treated by5-aminolevulinic acid-photodynamic therapy (ALA-PDT).Patients and methods:We conducted a six-month follow-up assessment of efficacy and sexual behavior of74Chinese CA patients after topical5-aminolevulinic acid-photodynamic therapy.Results:Six months post-treatment, complete clinical response rates were90.0%and recurrence rates were10.0%.69.8%of the respondents had resumed sexual activity of which56.8%did not consistently use a condom. The median duration of resumption of sexual activity was8weeks.Conclusions:PDT is associated with high cure rates and low recurrence rates in CA. A considerable proportion of the patients in this study did not adhere to the counseling messages regarding good sexual habits. Counseling programs need to be intensified if the intended results of reduction of HPV transmission rates are to be achieved.