Ketorolac + two-step irradiation reduces pain during ALA-PDT for CA :- Medznat

Ketorolac relieves pain during photodynamic therapy for genital warts

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As per the outcomes of a clinical study, combining ketorolac tromethamine with a two-step irradiation protocol during 5-aminolevulinic acid photodynamic therapy (ALA-PDT) markedly reduces pain and boosts patient satisfaction in the treatment of condyloma acuminatum (CA; also known as genital warts) — a condition commonly caused by human papillomavirus.

The study included 92 patients with CA, who were randomly segregated into 3 groups:

Combination group: Received ketorolac tromethamine with two-step irradiation — 65 mW/cm² for 5 minutes, followed by 80 mW/cm² for 16 minutes (total dose: 96 J/cm²).
Ketorolac group: Received ketorolac tromethamine with continuous irradiation at 80 mW/cm² for 20 minutes (96 J/cm²).
Control group: Received cold air analgesia with 80 mW/cm² irradiation for 20 minutes (96 J/cm²).

Pain levels were assessed via the visual analogue scale (VAS) at multiple time points during irradiation. A post-treatment questionnaire evaluated pain relief within 24 hours, adverse reactions, and overall satisfaction.

Key findings

Pain reduction: At both 1 and 5 minutes, patients in the combination group reported remarkably lower pain scores than those in the other two groups (median scores: 2.0 vs. 4.0 and 4.5 at 1 min; 5.0 vs. 6.0 and 7.0 at 5 min). All groups reached peak pain intensity between 5–10 minutes, but pain declined more rapidly in the ketorolac-treated groups.
Pain duration: Most patients in the combination and ketorolac groups experienced mild pain (VAS 1–3) and reported pain relief within 24 hours, whereas the control group commonly reported moderate to severe pain (VAS 4–7) lasting beyond 24 hours (χ² = 70.925, P < 0.001).
Adverse reactions: All 3 groups experienced mild local reactions such as redness, swelling, erosion, or scabbing, with no vital differences in safety outcomes (P > 0.05).
Patient satisfaction: The combination group exhibited the highest satisfaction rate, with 87.1% of patients reporting they were “very satisfied” and none were dissatisfied. In comparison, only 53.3% of patients in the control group reported high satisfaction (χ² = 10.351, P = 0.025).

This study yields strong evidence supporting the clinical feasibility and safety of using ketorolac tromethamine combined with two-step irradiation to improve pain management during ALA-PDT for CA.

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