Pain and pain management in dermatology

It is estimated that 23 million Germans suffer from chronic pain. A recent survey has revealed that 30% of chronic pain patients are dissatisfied with their pain management. Furthermore, five million Germans suffer from neuropathic pain, 20% of whom are inadequately treated. Pain is also a symptom of many dermatologic diseases, which is mostly somatic and may be classified as mild in the majority of cases. Nevertheless, research on the quality of life (QoL) has increasingly shown a marked impairment of QoL by moderate pain such as in psoriatic arthritis. Severe pain is associated with herpes zoster (shingles), leg ulcers, and pyoderma gangrenosum. This article addresses the basics of pain classification and, in a short excerpt, pain transduction/transmission and modulation. The use of standardized diagnostic scales is recommended for the purpose of recording and monitoring pain intensity, which allows for the optimization of therapy and consistent interdisciplinary communication. Any dermatology residency program includes the acquisition of knowledge and skills in pain management. This review therefore aims to present fundamental therapeutic concepts based on the expanded WHO analgesic ladder, and describes a step-wise therapeutic approach and combination therapies. The article focuses on the pain management of the above-mentioned severely painful, conservatively treated dermatoses. Besides well-established therapeutic agents and current therapeutic standards, it discusses specific options based on guidelines (where available). Current knowledge on peri-and postoperative pain management is briefly outlined. This article addresses: The fundamentals of the classification and neurophysiology of pain; Standards for pain documentation in children and adults; General standards for pharmaceutical pain management; Current specific treatment options for postherpetic neuralgia, leg ulcers, and pyoderma gangrenosum in conjunction with the expanded WHO analgesic ladder.