Variable pulsed light is less painful than light-emitting diodes for topical photodynamic therapy of actinic keratosis: A prospective randomized controlled trial

170 (74/95) and 63% (64/102) of the patients in the no analgesics and analgesics groups agreed that analgesic should not be recommended to other patients. Conclusions: The subjective pain during SWL was tolerable; therefore, routine analgesics are not required. However, on the initial SWL in young female patient, the application of analgesics is considerable. doi:10.1016/j.acpain.2007.08.004 Dexamethasone for the prophylaxis of radiationinduced pain flare after palliative radiotherapy for bone metastases—–A pilot study Support Care Cancer 2007;15(6):643—7 Chow E., Loblaw A., Harris K., Doyle M., Goh P., Chiu H., Panzarella T., Tsao M., Barnes E.A., Sinclair E., Farhadian M., Danjoux C. Purpose: To investigate the efficacy of dexamethasone as a prophylactic adjuvant analgesic to decrease pain flare and to assess its safety and tolerance of dexamethasone. Materials and methods: Patients treated with a single 8 Gy for bone metastases took 8 mg dexamethasone before the radiation treatment. The Brief Pain Inventory was administered at baseline and then daily for 10 days after radiation. Pain flare was defined as a two-point increase in the worst pain or a 25% increase in the analgesic intake when compared with the baseline. Results: Thirty-three patients (23 males, 10 females) had complete follow-up data. Their median age was 73 years old. Ten patients had progressive worsening pain during the entire 10-day follow-up. A total of eight patients (24%; 95% CI, 10—39%) experienced pain flare during the 10-day follow-up. Two patients had a 1-day pain flare on day 3. Three patients had a 1-day pain flare on day 7. Three other patients had a prolonged pain flare: one had a 3-day pain flare on days 2—4, one had a 3-day pain flare on days 4—6, and the other, a 6-day pain flare on days 3—8. The half-life of dexamethasone is 36—54 h. Only one patient (3%) experienced pain flare in the first 2 days of follow-up with the action of dexamethasone. Dexamethasone was well tolerated. Conclusion: Dexamethasone might be effective in the prophylaxis of radiation-induced pain flare after palliative radiotherapy for bone metastases. Randomized trials are required to confirm the finding. ©2007 Springer-Verlag. doi:10.1016/j.acpain.2007.08.005

Abstracts Variable pulsed light is less painful than lightemitting diodes for topical photodynamic therapy of actinic keratosis: A prospective randomized controlled trial Br J Dermatol 2007;157(1):111—7 Babilas P., Knobler R., Hummel S., Gottschaller C., Maisch T., Koller M., Landthaler M., Szeimies R.-M. Background: Photodynamic therapy (PDT) of actinic keratosis (AK) using methylaminolaevulinate (MAL) is an effective and safe treatment option, but the procedure is painful. Objectives: To evaluate the efficacy and pain associated with variable pulsed light (VPL), a prospective, randomized, controlled split-face study was performed. Methods: Topical MAL-PDT was conducted in 25 patients with AK (n = 238) who were suitable for two-sided comparison. After incubation with MAL, irradiation was performed with a light-emitting diode (LED) (50 mW cm−2 ; 37 J cm−2 ) versus VPL (80 J cm−2 , double pulsed at 40 J cm−2 , pulse train of 15 impulses each with a duration of 5 ms, 610—950 nm filtered hand piece) followed by reevaluation up to 3 months. Results: The pain during and after therapy was significantly lower with VPL irradiation [t (d.f. = 24) = 4.42, P < 0.001]. The overall mean ± S.D. infiltration and keratosis score at 3 months after treatment was 0.86 ± 0.71 (LED system) versus 1.05 ± 0.74 (VPL device) (no statistically significant difference; P = 0.292). Patient satisfaction following both treatment modalities did not significantly differ at the 3-month follow up (P = 0.425). Conclusions: VPL used for MAL-PDT is an efficient alternative for the treatment of AK that results in complete remission and cosmesis equivalent to LED irradiation but causes significantly less pain. ©2007 The Authors. doi:10.1016/j.acpain.2007.08.006 Nitrous oxide inhalation to improve patient acceptance and reduce procedure related pain of flexible cystoscopy for men younger than 55 years J Urol 2007;178(1):184—8 Calleary J.G., Masood J., Van-Mallaerts R., Barua J.M. Purpose: Flexible cystoscopy in men younger than 55 years is painful despite the current best standard anesthesia (20 ml 2% lidocaine gel 15 min before