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Pain Control in Dermatologic Conditions

  • Other Pain (AD. Kaye and N Vadivelu, Section Editors)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Pain management in dermatologic conditions can be complicated by the primary disease burden and associated decreased quality of life, disability, and psychosocial issues. This review focuses on pain management strategies in some of the more painful dermatologic conditions.

Recent Findings

Pain management in painful dermatologic conditions such as pyoderma gangrenosum, postherpetic neuralgia, lower limb ulcers, and hidradenitis suppurativa revolves around treatment of the underlying disease process. Topical agents such as topical steroids and systemic immunosuppressants with over-the-counter analgesics usually suffice in mild to moderate pain. Severe pain may need neuropathic agents and referral to interventional pain physicians for consideration of advanced techniques such as epidural steroid injections and sympathetic nerve blocks.

Summary

Part of the treatment process is for dermatologists to establish patient expectations and to treat pain within their scope of practice. More research is needed towards pain control in painful dermatologic conditions with elucidation of treatment algorithms unique to each condition.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Beiteke U, Bigge S, Reichenberger C, Gralow I. Pain and pain management in dermatology. J Dtsch Dermatol Ges. 2015;13(10):967–87.

    PubMed  Google Scholar 

  2. CDC/NCHS. National Vital Statistics System, Mortality. Atlanta: US Department of Health and Human Services.

  3. • Saco M, Golda N. Postoperative pain management in dermatologic surgery: a systematic review. Dermatol Clin. 2019;37(3):341–8 This systematic review focuses on the determinants of postoperative pain after dermatologic surgery, including anatomic site and repair types. This review highlights that many dermatologic procedures are associated with low levels of pain and opiods are often not necessary.

    Article  CAS  PubMed  Google Scholar 

  4. Yorkgitis BK, Brat GA. Postoperative opioid prescribing: getting it right. Am J Surg. 2018 Apr;215(4):707–11.

    Article  PubMed  Google Scholar 

  5. Firoz BF, Goldberg LH, Arnon O, Mamelak AJ. An analysis of pain and analgesia after Mohs micrographic surgery. J Am Acad Dermatol. 2010;63(1):79–86.

    Article  PubMed  Google Scholar 

  6. Limthongkul B, Samie F, Humphreys TR. Assessment of postoperative pain after Mohs micrographic surgery. Dermatol Surg. 2013;39(6):857–63.

    Article  CAS  PubMed  Google Scholar 

  7. Gameiro A, Pereira N, Cardoso JC, Gonçalo M. Pyoderma gangrenosum: challenges and solutions. Clin Cosmet Investig Dermatol. 2015;8:285–93.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14(2):162–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Waxman SG, Merkies ISJ, Gerrits MM, Dib-Hajj SD, Lauria G, Cox JJ, et al. Sodium channel genes in pain-related disorders: phenotype-genotype associations and recommendations for clinical use. Lancet Neurol. 2014;13(11):1152–60.

    Article  CAS  PubMed  Google Scholar 

  10. Meyer V, Kerk N, Meyer S, Goerge T. Differential diagnosis and therapy of leg ulcers. J Dtsch Dermatol Ges. 2011;9(12):1035–51 quiz 52.

    PubMed  Google Scholar 

  11. Cohen JI. Clinical practice: Herpes zoster. N Engl J Med. 2013;369(3):255–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Wulf H, Baron R. Prevention of postherpetic neuralgia: does it exist? Schmerz. 1997;11(6):373–7.

    Article  CAS  PubMed  Google Scholar 

  13. Wallace M, Pappagallo M. Qutenza®: a capsaicin 8% patch for the management of postherpetic neuralgia. Expert Rev Neurother. 2011;11(1):15–27.

    Article  CAS  PubMed  Google Scholar 

  14. Enamandram M, Rathmell JP, Kimball AB. Chronic pain management in dermatology: a guide to assessment and nonopioid pharmacotherapy. J Am Acad Dermatol. 2015;73(4):563–73 quiz 73-4.

    Article  PubMed  Google Scholar 

  15. Khadem T, Stevens V. Therapeutic options for the treatment of postherpetic neuralgia: a systematic review. J Pain Palliat Care Pharmacother. 2013;27(3):268–83.

    Article  PubMed  Google Scholar 

  16. Meng FY, Zhang LC, Liu Y, Pan LH, Zhu M, Li CL, et al. Efficacy and safety of gabapentin for treatment of postherpetic neuralgia: a meta-analysis of randomized controlled trials. Minerva Anestesiol. 2014;80(5):556–67.

    CAS  PubMed  Google Scholar 

  17. Shrestha M, Chen A. Modalities in managing postherpetic neuralgia. Korean J Pain. 2018;31(4):235–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Derry S, Rice AS, Cole P, Tan T, Moore RA. Topical capsaicin (high concentration) for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017;1:CD007393.

    PubMed  Google Scholar 

  19. Navez ML, Monella C, Bösl I, Sommer D, Delorme C. 5% lidocaine medicated plaster for the treatment of postherpetic neuralgia: a review of the clinical safety and tolerability. Pain Ther. 2015;4(1):1–15.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Boureau F, Legallicier P, Kabir-Ahmadi M. Tramadol in post-herpetic neuralgia: a randomized, double-blind, placebo-controlled trial. Pain. 2003;104(1-2):323–31.

    Article  CAS  PubMed  Google Scholar 

  21. Fujiwara A, Watanabe K, Hashizume K, Shinohara K, Kawaguchi M. Transforaminal vs interlaminar epidural steroid injection for acute-phase shingles: a randomized, prospective trial. Pain Physician. 2018;21(4):373–82.

    Article  PubMed  Google Scholar 

  22. Kim HJ, Ahn HS, Lee JY, Choi SS, Cheong YS, Kwon K, et al. Effects of applying nerve blocks to prevent postherpetic neuralgia in patients with acute herpes zoster: a systematic review and meta-analysis. Korean J Pain. 2017;30(1):3–17.

    Article  PubMed  Google Scholar 

  23. Texakalidis P, Tora MS, Boulis NM. Neurosurgeons’ armamentarium for the management of refractory postherpetic neuralgia: a systematic literature review. Stereotact Funct Neurosurg. 2019;97(1):55–65.

    Article  PubMed  Google Scholar 

  24. Raja SN, Haythornthwaite JA, Pappagallo M, Clark MR, Travison TG, Sabeen S, et al. Opioids versus antidepressants in postherpetic neuralgia: a randomized, placebo-controlled trial. Neurology. 2002;59(7):1015–21.

    Article  CAS  PubMed  Google Scholar 

  25. Jean WH, Wu CC, Mok MS, Sun WZ. Starting dose of gabapentin for patients with post-herpetic neuralgia--a dose-response study. Acta Anaesthesiol Taiwanica. 2005;43(2):73–7.

    Google Scholar 

  26. Johnson RW, Rice AS. Clinical practice. Postherpetic neuralgia. N Engl J Med. 2014;371(16):1526–33.

    Article  CAS  PubMed  Google Scholar 

  27. • Green J, Jester R, McKinley R, Pooler A. The impact of chronic venous leg ulcers: a systematic review. J Wound Care. 2014;23(12):601–12 This systematic review highlights the psychosocial and functional burdens that are faced by patients with chronic venous ulcers. These burdens are often ignored or not properly addressed by providers.

    Article  CAS  PubMed  Google Scholar 

  28. Brandenburg VM, Martin H, Sohn CM, Ketteler M. Calciphylaxis. Dtsch Med Wochenschr. 2015;140(5):347–51.

    PubMed  Google Scholar 

  29. Menon R, Swanepoe A. Continuing education in anaesthesia. Crit Care Pain. 2010;10(3):88–92.

    Google Scholar 

  30. Freedman G, Entero H, Brem H. Practical treatment of pain in patients with chronic wounds: pathogenesis-guided management. Am J Surg. 2004;188(1A Suppl):31–5.

    Article  PubMed  Google Scholar 

  31. Smith HS, Chao JD, Teitelbaum J. Painful hidradenitis suppurativa. Clin J Pain. 2010;26(5):435–44.

    Article  PubMed  Google Scholar 

  32. Alikhan A, Lynch PJ, Eisen DB. Hidradenitis suppurativa: a comprehensive review. J Am Acad Dermatol. 2009;60(4):539–61 quiz 62-3.

    Article  PubMed  Google Scholar 

  33. Paletta C, Jurkiewicz MJ. Hidradenitis suppurativa. Clin Plast Surg. 1987;14(2):383–90.

    Article  CAS  PubMed  Google Scholar 

  34. Mendonça CO, Griffiths CE. Clindamycin and rifampicin combination therapy for hidradenitis suppurativa. Br J Dermatol. 2006;154(5):977–8.

    Article  PubMed  Google Scholar 

  35. Kaur MR, Lewis HM. Hidradenitis suppurativa treated with dapsone: a case series of five patients. J Dermatolog Treat. 2006;17(4):211–3.

    Article  CAS  PubMed  Google Scholar 

  36. Aksakal AB, Adişen E. Hidradenitis suppurativa: importance of early treatment; efficient treatment with electrosurgery. Dermatol Surg. 2008;34(2):228–31.

    Article  CAS  PubMed  Google Scholar 

  37. Mandal A, Watson J. Experience with different treatment modules in hidradenitis suppurativa: a study of 106 cases. Surgeon. 2005;3(1):23–6.

    Article  CAS  PubMed  Google Scholar 

  38. Meeks JP, Holy TE. Electrical recordings from the accessory olfactory bulb in VNO-AOB ex vivo preparations. Methods Mol Biol. 2013;1068:237–46.

    Article  PubMed  Google Scholar 

  39. Horváth B, Janse IC, Sibbald GR. Pain management in patients with hidradenitis suppurativa. J Am Acad Dermatol. 2015;73(5 Suppl 1):S47–51.

    Article  PubMed  Google Scholar 

  40. Ritchlin C, Scher JU. Strategies to improve outcomes in psoriatic arthritis. Curr Rheumatol Rep. 2019;21(12):72.

    Article  PubMed  Google Scholar 

  41. Husni ME, Merola JF, Davin S. The psychosocial burden of psoriatic arthritis. Semin Arthritis Rheum. 2017;47(3):351–60.

    Article  PubMed  Google Scholar 

  42. Coates LC, Kavanaugh A, Mease PJ, Soriano ER, Laura Acosta-Felquer M, Armstrong AW, et al. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis 2015 Treatment Recommendations for Psoriatic Arthritis. Arthritis Rheum. 2016;68(5):1060–71.

    Google Scholar 

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Correspondence to Kanishka Rajput.

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Vijay Kodumudi, David Lam, and Kanishka Rajput declare no conflict of interest.

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Kodumudi, V., Lam, D. & Rajput, K. Pain Control in Dermatologic Conditions. Curr Pain Headache Rep 25, 38 (2021). https://doi.org/10.1007/s11916-021-00955-2

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