Skip to main content
SpringerLink
Log in

Management of Pain Associated with Selected Conditions in Dermatology

  • Therapy in Practice
  • Published:
American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

Dermatologists face a wide range of pain control challenges in daily practice, from the transient pain of dermatologic surgery to the persistent pain that plagues some chronic dermatologic conditions. Although the pathophysiology of pain is well described and the profound impact of dermatological pain on patients’ quality of life is well appreciated, there is an identified need for clear therapeutic plans for providing symptomatic pain relief of common painful dermatoses. In this paper, we will review and clearly outline approaches to pain management of a number of common painful dermatoses such as herpes zoster and post-herpetic neuralgia, ulcers, oral dermatoses, dysesthesias, and many others.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Nashan D, Meiss F, Gralow I. Pain: basics and relevance in dermatology. J Dtsch Dermatol Ges. 2009;7(8):704–17.

    PubMed  Google Scholar 

  2. Bhullar S, Gill JS, Beecker J. Gaps in pain management in dermatology: a needs assessment from Canada. J Am Acad Dermatol. 2014;71(6):1258–9 e2.

  3. WHO. Cancer pain relief: with a guide to opioid availability, 2nd ed. Geneva; 1996.

  4. Argoff CE, Viscusi ER. The use of opioid analgesics for chronic pain: minimizing the risk for harm. Am J Gastroenterol. 2014;2(1):3–8.

    Article  CAS  Google Scholar 

  5. Volkow ND, McLellan AT. Opioid abuse in chronic pain-misconceptions and mitigation strategies. N Engl J Med. 2016;374(13):1253–63.

    Article  CAS  PubMed  Google Scholar 

  6. Vargas-Schaffer G. Is the WHO analgesic ladder still valid? Twenty-four years of experience. Can Fam Physician. 2010;56(6):514–7, e202–5.

  7. Wollina U. Pyoderma gangrenosum–a review. Orphanet J Rare Dis. 2007;2:19.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ahronowitz I, Harp J, Shinkai K. Etiology and management of pyoderma gangrenosum: a comprehensive review. Am J Clin Dermatol. 2012;13(3):191–211.

    Article  PubMed  Google Scholar 

  9. Wollina U, Karamfilov T. Treatment of recalcitrant ulcers in pyoderma gangrenosum with mycophenolate mofetil and autologous keratinocyte transplantation on a hyaluronic acid matrix. J Eur Acad Dermatol Venereol. 2000;14(3):187–90.

    Article  CAS  PubMed  Google Scholar 

  10. Vieira WA, Barbosa LR, Martin LM. Hyperbaric oxygen therapy as an adjuvant treatment for pyoderma gangrenosum. An Bras Dermatol. 2011;86(6):1193–6.

    PubMed  Google Scholar 

  11. Tremaine WJ. Treatment of erythema nodosum, aphthous stomatitis, and pyoderma gangrenosum in patients with IBD. Inflamm Bowel Dis. 1998;4(1):68–9 (discussion 73).

  12. Cohen PR. Sweet’s syndrome–a comprehensive review of an acute febrile neutrophilic dermatosis. Orphanet J Rare Dis. 2007;2:34.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Moreland LW, Brick JE, Kovach RE, DiBartolomeo AG, Mullins MC. Acute febrile neutrophilic dermatosis (Sweet syndrome): a review of the literature with emphasis on musculoskeletal manifestations. Semin Arthritis Rheum. 1988;17(3):143–53.

    Article  CAS  PubMed  Google Scholar 

  14. Bello Lopez JL, Fonseca E, Manso F. Sweet’s syndrome during the chronic phase of chronic myeloid leukaemia. Acta Haematol. 1990;84(4):207–8.

    Article  CAS  PubMed  Google Scholar 

  15. Callen JP. Colchicine is effective in controlling chronic cutaneous leukocytoclastic vasculitis. J Am Acad Dermatol. 1985;13(2 Pt 1):193–200.

    Article  CAS  PubMed  Google Scholar 

  16. Armitage M, Roberts J. Caring for patients with leg ulcers and an underlying vasculitic condition. Br J Community Nurs. 2004;Suppl:S16–22.

  17. Schwartz RA, Nervi SJ. Erythema nodosum: a sign of systemic disease. Am Fam Physician. 2007;75(5):695–700.

    PubMed  Google Scholar 

  18. Marshall JK, Irvine EJ. Successful therapy of refractory erythema nodosum associated with Crohn’s disease using potassium iodide. Can J Gastroenterol. 1997;11(6):501–2.

    Article  CAS  PubMed  Google Scholar 

  19. Shen MC, Lin HH, Lee SS, Chen YS, Chiang PC, Liu YC. Double-blind, randomized, acyclovir-controlled, parallel-group trial comparing the safety and efficacy of famciclovir and acyclovir in patients with uncomplicated herpes zoster. J Microbiol Immunol Infect. 2004;37(2):75–81.

    CAS  PubMed  Google Scholar 

  20. Sampathkumar P, Drage LA, Martin DP. Herpes zoster (shingles) and postherpetic neuralgia. Mayo Clin Proc. 2009;84(3):274–80.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wood MJ, Johnson RW, McKendrick MW, Taylor J, Mandal BK, Crooks J. A randomized trial of acyclovir for 7 days or 21 days with and without prednisolone for treatment of acute herpes zoster. N Engl J Med. 1994;330(13):896–900.

    Article  CAS  PubMed  Google Scholar 

  22. Doble S. Management of patients with post-herpetic neuralgia. Nurs Stand. 2008;22(39):49–56 (quiz 8, 60).

  23. Harke H, Gretenkort P, Ladleif HU, Koester P, Rahman S. Spinal cord stimulation in postherpetic neuralgia and in acute herpes zoster pain. Anesth Analg. 2002;94(3):694–700 (table of contents).

  24. Kanai A, Okamoto T, Suzuki K, Niki Y, Okamoto H. Lidocaine eye drops attenuate pain associated with ophthalmic postherpetic neuralgia. Anesth Analg. 2010;110(5):1457–60.

    Article  CAS  PubMed  Google Scholar 

  25. 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 

  26. Kanazi GE, Johnson RW, Dworkin RH. Treatment of postherpetic neuralgia: an update. Drugs. 2000;59(5):1113–26.

    Article  CAS  PubMed  Google Scholar 

  27. Jones VM, Moore KA, Peterson DM. Capsaicin 8 % topical patch (Qutenza)–a review of the evidence. J Pain Palliat Care Pharmacother. 2011;25(1):32–41.

    Article  PubMed  Google Scholar 

  28. Burgess JA, Johnson BD, Sommers E. Pharmacological management of recurrent oral mucosal ulceration. Drugs. 1990;39(1):54–65.

    Article  CAS  PubMed  Google Scholar 

  29. McBride DR. Management of aphthous ulcers. Am Fam Physician. 2000;62(1):149–54, 60.

  30. Scully C. Clinical practice. Aphthous ulceration. N Engl J Med. 2006;355(2):165–72.

    Article  CAS  PubMed  Google Scholar 

  31. Lalla RV, Sonis ST, Peterson DE. Management of oral mucositis in patients who have cancer. Dent Clin North Am. 2008;52(1):61–77, viii.

  32. Harris DJ. Cancer treatment-induced mucositis pain: strategies for assessment and management. Ther Clin Risk Manag. 2006;2(3):251–8.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Turhal NS, Erdal S, Karacay S. Efficacy of treatment to relieve mucositis-induced discomfort. Support Care Cancer. 2000;8(1):55–8.

    CAS  PubMed  Google Scholar 

  34. Keefe DM, Schubert MM, Elting LS, Sonis ST, Epstein JB, Raber-Durlacher JE, et al. Updated clinical practice guidelines for the prevention and treatment of mucositis. Cancer. 2007;109(5):820–31.

    Article  CAS  PubMed  Google Scholar 

  35. Lalla RV, Peterson DE. Oral mucositis. Dent Clin N Am. 2005;49(1):167–84, ix.

  36. Navazesh M, Ship II. Xerostomia: diagnosis and treatment. Am J Otolaryngol. 1983;4(4):283–92.

    Article  CAS  PubMed  Google Scholar 

  37. Perez-Perez LC. General features and treatment of notalgia paresthetica. Skinmed. 2011;9(6):353–8 (quiz 9).

  38. Lane JE, McKenzie JT, Spiegel J. Brachioradial pruritus: a case report and review of the literature. Cutis. 2008;81(1):37–40.

    PubMed  Google Scholar 

  39. Stellon A. Neurogenic pruritus: an unrecognised problem? A retrospective case series of treatment by acupuncture. Acupunct Med. 2002;20(4):186–90.

    Article  PubMed  Google Scholar 

  40. Richardson BS, Way BV, Speece AJ 3rd. Osteopathic manipulative treatment in the management of notalgia paresthetica. J Am Osteopath Assoc. 2009;109(11):605–8.

    PubMed  Google Scholar 

  41. Perez-Perez L, Allegue F, Fabeiro JM, Caeiro JL, Zulaica A. Notalgia paresthesica successfully treated with narrow-band UVB: report of five cases. J Eur Acad Dermatol Venereol. 2010;24(6):730–2.

    Article  CAS  PubMed  Google Scholar 

  42. Goulden V, Toomey PJ, Highet AS. Successful treatment of notalgia paresthetica with a paravertebral local anesthetic block. J Am Acad Dermatol. 1998;38(1):114–6.

    Article  CAS  PubMed  Google Scholar 

  43. Loosemore MP, Bordeaux JS, Bernhard JD. Gabapentin treatment for notalgia paresthetica, a common isolated peripheral sensory neuropathy. J Eur Acad Dermatol Venereol. 2007;21(10):1440–1.

    Article  CAS  PubMed  Google Scholar 

  44. Savk E, Savk O, Sendur F. Transcutaneous electrical nerve stimulation offers partial relief in notalgia paresthetica patients with a relevant spinal pathology. J Dermatol. 2007;34(5):315–9.

    Article  PubMed  Google Scholar 

  45. Poterucha TJ, Murphy SL, Davis MD, Sandroni P, Rho RH, Warndahl RA, et al. Topical amitriptyline-ketamine for the treatment of brachioradial pruritus. JAMA Dermatol. 2013;149(2):148–50.

    Article  PubMed  Google Scholar 

  46. Ally MS, Gamba CS, Peng DH, Tang JY. The use of aprepitant in brachioradial pruritus. JAMA Dermatol. 2013;149(5):627–8.

    Article  PubMed  Google Scholar 

  47. Shumway NK, Cole E, Fernandez KH. Neurocutaneous disease: neurocutaneous dysesthesias. J Am Acad Dermatol. 2016;74(2):215–28.

    Article  PubMed  Google Scholar 

  48. Shah M, Hoffstetter S. Vulvodynia. Obstet Gynecol Clin N Am. 2014;41(3):453–64.

    Article  Google Scholar 

  49. Hartmann D. Chronic vulvar pain from a physical therapy perspective. Dermatol Ther. 2010;23(5):505–13.

    Article  PubMed  Google Scholar 

  50. Jensen TS, Finnerup NB. Allodynia and hyperalgesia in neuropathic pain: clinical manifestations and mechanisms. Lancet Neurol. 2014;13(9):924–35.

    Article  PubMed  Google Scholar 

  51. Yucel A, Ozyalcin S, Koknel Talu G, Kiziltan E, Yucel B, Andersen OK, et al. The effect of venlafaxine on ongoing and experimentally induced pain in neuropathic pain patients: a double blind, placebo controlled study. Eur J Pain. 2005;9(4):407–16.

    Article  CAS  PubMed  Google Scholar 

  52. Vranken JH, Hollmann MW, van der Vegt MH, Kruis MR, Heesen M, Vos K, et al. Duloxetine in patients with central neuropathic pain caused by spinal cord injury or stroke: a randomized, double-blind, placebo-controlled trial. Pain. 2011;152(2):267–73.

    Article  CAS  PubMed  Google Scholar 

  53. Kishore-Kumar R, Max MB, Schafer SC, Gaughan AM, Smoller B, Gracely RH, et al. Desipramine relieves postherpetic neuralgia. Clin Pharmacol Ther. 1990;47(3):305–12.

    Article  CAS  PubMed  Google Scholar 

  54. Nurmikko TJ, Serpell MG, Hoggart B, Toomey PJ, Morlion BJ, Haines D. Sativex successfully treats neuropathic pain characterised by allodynia: a randomised, double-blind, placebo-controlled clinical trial. Pain. 2007;133(1–3):210–20.

    Article  CAS  PubMed  Google Scholar 

  55. Vestergaard K, Andersen G, Gottrup H, Kristensen BT, Jensen TS. Lamotrigine for central poststroke pain: a randomized controlled trial. Neurology. 2001;56(2):184–90.

    Article  CAS  PubMed  Google Scholar 

  56. Kim JS, Bashford G, Murphy TK, Martin A, Dror V, Cheung R. Safety and efficacy of pregabalin in patients with central post-stroke pain. Pain. 2011;152(5):1018–23.

    Article  CAS  PubMed  Google Scholar 

  57. Ranoux D, Attal N, Morain F, Bouhassira D. Botulinum toxin type A induces direct analgesic effects in chronic neuropathic pain. Ann Neurol. 2008;64(3):274–83.

    Article  PubMed  Google Scholar 

  58. Rowbotham MC, Davies PS, Fields HL. Topical lidocaine gel relieves postherpetic neuralgia. Ann Neurol. 1995;37(2):246–53.

    Article  CAS  PubMed  Google Scholar 

  59. Teixeira MJ, Okada M, Moscoso AS, Puerta MY, Yeng LT, Galhardoni R, et al. Methadone in post-herpetic neuralgia: a pilot proof-of-concept study. Clinics (Sao Paulo). 2013;68(7):1057–60.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Hoss D, Segal S. Scalp dysesthesia. Arch Dermatol. 1998;134(3):327–30.

    Article  CAS  PubMed  Google Scholar 

  61. Sarifakioglu E, Onur O. Women with scalp dysesthesia treated with pregabalin. Int J Dermatol. 2013;52(11):1417–8.

    Article  CAS  PubMed  Google Scholar 

  62. Jimson S, Rajesh E, Krupaa RJ, Kasthuri M. Burning mouth syndrome. J Pharm Bioallied Sci. 2015;7(Suppl 1):S194–6.

    PubMed  PubMed Central  Google Scholar 

  63. Miziara I, Chagury A, Vargas C, Freitas L, Mahmoud A. Therapeutic options in idiopathic burning mouth syndrome: literature review. Int Arch Otorhinolaryngol. 2015;19(1):86–9.

    Article  PubMed  Google Scholar 

  64. Aravindhan R, Vidyalakshmi S, Kumar MS, Satheesh C, Balasubramanium AM, Prasad VS. Burning mouth syndrome: a review on its diagnostic and therapeutic approach. J Pharm Bioallied Sci. 2014;6(Suppl 1):S21–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Lopez-D’alessandro E, Escovich L. Combination of alpha lipoic acid and gabapentin, its efficacy in the treatment of Burning Mouth Syndrome: a randomized, double-blind, placebo controlled trial. Med Oral Patol Oral Cir Bucal. 2011;16(5):e635–40.

    Article  PubMed  Google Scholar 

  66. Scardina GA, Ruggieri A, Provenzano F, Messina P. Burning mouth syndrome: is acupuncture a therapeutic possibility? Br Dent J. 2010;209(1):E2.

    Article  CAS  PubMed  Google Scholar 

  67. Leclercq D, Thiebaut JB, Heran F. Trigeminal neuralgia. Diagn Interv Imaging. 2013;94(10):993–1001.

    Article  CAS  PubMed  Google Scholar 

  68. Montano N, Conforti G, Di Bonaventura R, Meglio M, Fernandez E, Papacci F. Advances in diagnosis and treatment of trigeminal neuralgia. Ther Clin Risk Manag. 2015;11:289–99.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Hu Y, Guan X, Fan L, Li M, Liao Y, Nie Z, et al. Therapeutic efficacy and safety of botulinum toxin type A in trigeminal neuralgia: a systematic review. J Headache Pain. 2013;14:72.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Falaki F, Nejat AH, Dalirsani Z. The effect of low-level laser therapy on trigeminal neuralgia: a review of literature. J Dent Res Dent Clin Dent Prospects. 2014;8(1):1–5.

    PubMed  PubMed Central  Google Scholar 

  71. Obermann M, Yoon MS, Sensen K, Maschke M, Diener HC, Katsarava Z. Efficacy of pregabalin in the treatment of trigeminal neuralgia. Cephalalgia. 2008;28(2):174–81.

    CAS  PubMed  Google Scholar 

  72. Lunardi G, Leandri M, Albano C, Cultrera S, Fracassi M, Rubino V, et al. Clinical effectiveness of lamotrigine and plasma levels in essential and symptomatic trigeminal neuralgia. Neurology. 1997;48(6):1714–7.

    Article  CAS  PubMed  Google Scholar 

  73. Fromm GH, Terrence CF, Chattha AS, Glass JD. Baclofen in trigeminal neuralgia: its effect on the spinal trigeminal nucleus: a pilot study. Arch Neurol. 1980;37(12):768–71.

    Article  CAS  PubMed  Google Scholar 

  74. Kanai A, Suzuki A, Kobayashi M, Hoka S. Intranasal lidocaine 8 % spray for second-division trigeminal neuralgia. Br J Anaesth. 2006;97(4):559–63.

    Article  CAS  PubMed  Google Scholar 

  75. Gilron I, Booher SL, Rowan MS, Smoller MS, Max MB. A randomized, controlled trial of high-dose dextromethorphan in facial neuralgias. Neurology. 2000;55(7):964–71.

    Article  CAS  PubMed  Google Scholar 

  76. Sindrup SH, Jensen TS. Pharmacotherapy of trigeminal neuralgia. Clin J Pain. 2002;18(1):22–7.

    Article  PubMed  Google Scholar 

  77. Liu H, Li H, Xu M, Chung KF, Zhang SP. A systematic review on acupuncture for trigeminal neuralgia. Altern Ther Health Med. 2010;16(6):30–5.

    PubMed  Google Scholar 

  78. Monrad SU, Terrell JE, Aronoff DM. The trigeminal trophic syndrome: an unusual cause of nasal ulceration. J Am Acad Dermatol. 2004;50(6):949–52.

    Article  PubMed  Google Scholar 

  79. Goodnight JW, Calcaterra T. Trigeminal trophic syndrome: a report of two cases and review. Am J Otolaryngol. 1994;15(3):219–22.

    Article  CAS  PubMed  Google Scholar 

  80. Nakamizo S, Miyachi Y, Kabashima K. Treatment of neuropathic itch possibly due to trigeminal trophic syndrome with 0.1 % topical tacrolimus and gabapentin. Acta Derm Venereol. 2010;90(6):654–5.

    Article  PubMed  Google Scholar 

  81. Fruhauf J, Schaider H, Massone C, Kerl H, Mullegger RR. Carbamazepine as the only effective treatment in a 52-year-old man with trigeminal trophic syndrome. Mayo Clin Proc. 2008;83(4):502–4.

    Article  PubMed  Google Scholar 

  82. Finlay AY. Trigeminal trophic syndrome. Arch Dermatol. 1979;115(9):1118.

    Article  CAS  PubMed  Google Scholar 

  83. Duke EE. Clinical experience with pimozide: emphasis on its use in postherpetic neuralgia. J Am Acad Dermatol. 1983;8(6):845–50.

    Article  CAS  PubMed  Google Scholar 

  84. Tada J, Ueda M, Abe Y, Fujiwara H, Arakawa K, Arata J. Trigeminal trophic syndrome–a report of three patients. J Dermatol. 1991;18(10):613–5.

    Article  CAS  PubMed  Google Scholar 

  85. Westerhof W, Bos JD. Trigeminal trophic syndrome: a successful treatment with transcutaneous electrical stimulation. Br J Dermatol. 1983;108(5):601–4.

    Article  CAS  PubMed  Google Scholar 

  86. Kurien AM, Damian DL, Moloney FJ. Trigeminal trophic syndrome treated with thermoplastic occlusion. Australas J Dermatol. 2011;52(1):e1–4.

    Article  PubMed  Google Scholar 

  87. Valdovinos ST, Landry GJ. Raynaud syndrome. Tech Vasc Interv Radiol. 2014;17(4):241–6.

    Article  PubMed  Google Scholar 

  88. Smith L, Polsky D, Franks AG Jr. Botulinum toxin-A for the treatment of Raynaud syndrome. Arch Dermatol. 2012;148(4):426–8.

    Article  CAS  PubMed  Google Scholar 

  89. Coleiro B, Marshall SE, Denton CP, Howell K, Blann A, Welsh KI, et al. Treatment of Raynaud’s phenomenon with the selective serotonin reuptake inhibitor fluoxetine. Rheumatology (Oxford). 2001;40(9):1038–43.

    Article  CAS  Google Scholar 

  90. Milio G, Corrado E, Genova C, Amato C, Raimondi F, Almasio PL, et al. Iloprost treatment in patients with Raynaud’s phenomenon secondary to systemic sclerosis and the quality of life: a new therapeutic protocol. Rheumatology (Oxford). 2006;45(8):999–1004.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Medicine, McGill University, Montréal, QC, Canada

    Feras M. Al-Ghazawi

  2. Division of Rheumatology (Dermatology), Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada

    Michele L. Ramien

  3. Division of Dermatology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada

    Michele L. Ramien

  4. Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada

    Alain Brassard

  5. Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

    Neil H. Shear

  6. Division of Dermatology, Department of Medicine, The Ottawa Hospital, University of Ottawa, Civic Campus, Ground Floor East, Rm 13, 737 Parkdale Ave, Ottawa, ON, K1Y, Canada

    Jennifer Beecker

Authors
  1. Feras M. Al-Ghazawi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michele L. Ramien
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alain Brassard
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Neil H. Shear
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jennifer Beecker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jennifer Beecker.

Ethics declarations

Funding

No funding was received for the preparation of this review.

Conflict of interest

Feras M. Al-Ghazawi, Michele L. Ramien, Alain Brassard, Neil H. Shear, and Jennifer Beecker have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Al-Ghazawi, F.M., Ramien, M.L., Brassard, A. et al. Management of Pain Associated with Selected Conditions in Dermatology. Am J Clin Dermatol 17, 463–474 (2016). https://doi.org/10.1007/s40257-016-0200-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40257-016-0200-x

Keywords

Search

Navigation