UV Therapy for Pain Management
UV therapy is not indicated for pain management as a primary treatment modality. The available evidence addresses UV phototherapy exclusively for dermatological conditions, with pain documented only as an adverse effect rather than a therapeutic target 1.
Primary Indications for UV Therapy
UV phototherapy is established as second-line treatment for specific dermatological conditions, not pain syndromes 2, 3:
- Psoriasis - PUVA with topical or oral psoralen is recommended for palmoplantar psoriasis (strength of recommendation C) 1
- Atopic dermatitis/eczema - Oral PUVA should be considered first-line for palmoplantar dermatoses (strength of recommendation D) 1
- Cutaneous T-cell lymphomas 2
- Vitiligo vulgaris 2
- Sclerotic skin diseases - UVA-1 phototherapy shows efficacy for localized scleroderma and related conditions 4
Pain as an Adverse Effect, Not Treatment Target
The British Association of Dermatologists guidelines explicitly document pain as an uncommon but important adverse effect of PUVA therapy 1:
- Severe skin pain occurs in approximately 4% of patients receiving PUVA 1
- Pain during photodynamic therapy is significant, with approximately 20% experiencing severe pain 5
- Painful erythema requires clear documentation as part of safety monitoring 1
Mechanism of Action (Not Pain-Related)
UV therapy works through immunomodulatory and anti-inflammatory mechanisms targeting skin pathology 2:
- Immediate effects: DNA photoproduct formation, apoptosis of keratinocytes and activated T-lymphocytes, cell membrane damage 2
- Delayed effects: Prostaglandin synthesis, cytokine modulation (IL-1 receptor antagonist induction, IL-2 decrease, IL-10 increase), systemic immune suppression 2
- Tissue penetration: UVB affects epidermis and epidermodermal junction; UVA affects epidermis, dermis, and blood vessels 2
These mechanisms address inflammatory skin conditions, not pain pathways directly 2, 6.
Critical Safety Considerations
Long-term carcinogenic risks make UV therapy inappropriate for non-dermatological indications 1:
- Patients receiving >200 PUVA treatments have approximately 30 times the risk of developing nonmelanoma skin cancer compared to the general population 1
- Squamous cell carcinoma risk increases in a dose-dependent manner 1
- PUVA is mutagenic, carcinogenic, and immunosuppressive 1
Clinical Bottom Line
UV phototherapy should only be used for established dermatological indications under specialist supervision 1. There is no evidence supporting its use for pain management, and the documented occurrence of pain as an adverse effect further contradicts this application 1. Patients seeking pain relief should be directed toward evidence-based analgesic approaches rather than UV therapy 1.