Post procedural pain with photodynamic therapy is more severe than skin surgery

J Plast Reconstr Aesthet Surg. 2015 Feb;68(2):e28-32. doi: 10.1016/j.bjps.2013.02.002. Epub 2013 Mar 13.


Objective: To compare prospective data on pain experienced by patients undergoing large facial skin cancer surgery with pain experienced with novel face photodynamic therapy (PDT).

Design: A comparison of pain data sets from two prospective trials in the same centre.

Setting: Referral skin cancer centre in Australia.

Protocol: 34 PDT patients had two aminolevulinate treatments to the face two weeks apart. 68 Surgery patients, matched 2:1 for gender and age, had large skin cancer excisional surgery to the face and closure with flap, graft or wedge reconstruction.

Main outcome measure(s): Severity of pain during and following procedure.

Results: The only patients describing their experience as the worst pain of their life were 4 PDT patients (12%). The median and mean pain scores for PDT patients were significantly higher than for extensive facial large face surgery, (p<0.001). Further analyses comparing PDT to patients having all skin cancer surgery on the face (N=170) matched for gender and age demonstrated more pain experienced with PDT. PDT is significantly more likely to result in pain requiring strong analgesia or pain beyond strong analgesics than skin cancer surgery including large facial operations.

Discussion and conclusions: Clinicians should consider explaining the relative likelihood of more severe pain whenever PDT is considered over surgery. The pain experienced with this PDT product may not reflect the pain experienced with other PDT products.

Keywords: Actinic keratoses; Analgesia; Pain; Photodynamic; Prospective; Reconstruction.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Aminolevulinic Acid / therapeutic use
  • Analgesics / therapeutic use
  • Facial Neoplasms / drug therapy*
  • Facial Neoplasms / surgery*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pain / drug therapy
  • Pain / etiology*
  • Pain / physiopathology
  • Pain Measurement
  • Pain, Postoperative / physiopathology
  • Photochemotherapy / adverse effects*
  • Photosensitizing Agents / therapeutic use
  • Prospective Studies
  • Randomized Controlled Trials as Topic
  • Skin Neoplasms / drug therapy*
  • Skin Neoplasms / surgery*


  • Analgesics
  • Photosensitizing Agents
  • Aminolevulinic Acid