Pain and itch are two very different things, both of which may be experienced by dermatology patients. While they both provide an unpleasant feeling, they have an important protective function. Itch is usually located in the skin and close mucosa, while pain can be felt anywhere throughout the body. IL-2, IL-13, and IL-31 are traditionally involved in itch, while pain can involve numerous different cytokines. Each also may increase or decrease with cold/heat or types of opioids.
Skin pain may result from any number of issues such as wounds, pressure and leg ulcers, burns, as well as iatrogenic pain and diseases. Chronic pain is also associated with many skin disorders such as atopic dermatitis, psoriasis, reactive skin, and others.
Some of the sensations associated with pain include:1
Pain with dermatology conditions signifies a poorly treated disorder. Naturally, pain is a main concern of patients and it must be searched systematically. The patient or caregiver should be questioned, but patients may fear that pain is a result of a worsening pathology. In addition, some patients may have difficulty expressing pain because of psychiatric or functional disorders. Regardless of these issues, pain should be actively treated and systematically prevented.
There are a number of scales that can be used to assess pain. Some of these are listed here:
The identification and scale of neuropathic pain is slightly different and a DN4 (Douleur Neuropathique 4 questions) questionnaire is useful to determine the presence of pain. Neuropathic pain may include any of the following sensations; stabbing, pins and needles, throbbing, burning, electric shock-like, numbness, and shooting pains.
There are a number of medications that may be used to treat skin pain. A sampling of these include:
The placebo and nocebo effect have been shown to be effective in 30% to 70% of patients with pruritis or pain. The placebo and nocebo effect do not have a known relationship with any underlying psychological disorder.
In a meta-analysis, the placebo effect on itch was systematically investigated in clinical trials including patients with chronic itch due to atopic dermatitis, psoriasis, or chronic idiopathic urticaria.2 Placebo treatment significantly decreased itch, indicating that placebo effect has a considerable role in these patients.3
Present disclosure: The presenter disclosed that he has worked with A-Derma, Amgen, Biogen, Celgene, and Pfizer.
Written by: Debbie Anderson, PhD
Reviewed by: Victor Desmond Mandel, MD