Management of Pain Associated with Selected Conditions in Dermatology

Dermatological Conditions Inducing Acute and Chronic Pain

Pain is a common condition in dermatology. The aim of this review is to analyse the characteristics of pain in dermatology. Some skin diseases are conventionally known to cause pain; e.g. ulcers, pyoderma gangrenosum and herpes zoster. Common dermatoses, such as psoriasis or atopic dermatitis, can also cause significant pain. Some conditions are characterized by neuropathic pain and/or pruritus, without visible primary lesions: e.g. the neurocutaneous diseases, including small fibre neuropathies. Patients often fear pain in skin surgery; however, surgical procedures are rather well tolerated and any pain is mainly due to administration of local anaesthetic. Some therapies may also be uncomfortable for the patient, such as photodynamic therapy or aesthetic procedures. Thus, pain in dermatology is common, and its aetiology and characteristics are very varied. Knowledge of the different situations that cause pain will enable dermatologists to propose suitable analgesic solutions.

Dermatologists are increasing their use of non-opioid pain medications faster than opioids

INTRODUCTION

There is a lack of consensus in the literature on how and when dermatologists should prescribe pain medications. As there is an ongoing opioid abuse epidemic driven by prescription opioids, it is important for all fields to investigate their own prescribing patterns.

METHODS

We analyzed the National Ambulatory Medical Care Survey from 2007 to 2016 to assess the usage of systemic pain medications amongst dermatologists.

RESULTS

There were 16,777 total visits with dermatologists which represents 368 (95% confidence interval 363, 373) million estimated visits. Opioids were used at 1.4% (1.3, 1.6) of visits. As relative proportions, opioids were 35.6 (31.7, 39.6) of all systemic pain medication and non-opioids were 64.4% (53.8, 74.9). The use of opioid (p=.01 [odds ratio 1.08 (1.02, 1.14)]) and non-opioid (p<.001 [odds ratio 1.12 (1.07, 1.17)]) medications increased over the study interval.

CONCLUSION

Pain medications were used at a relatively small proportion of visits with dermatologists. Opioids were nearly half of all pain medications used. The use of opioids and non-opioids rose over the study interval, however, non-opioids rose at a faster rate. The faster rise of non-opioids may indicate that dermatologists are making an effort to use medications with less potential for abuse.