Peter Lio, MD: Minimizing Painful Pediatric Dermatologic Procedures

The combined pharmacological and surgical treatment offerings of dermatology are a great benefit for specialists who may have more options to navigate in a single patient visit. But the same gift is also a challenge to dermatologists, as they run risk of subjecting patients to more painful procedures.

In impressionable pediatric patients, a negative, uncomfortable experience may make a significant difference in their long-term disease management. But there are a number of ways that specialists may deliberately work to take pain out of the equation with any procedure.

In an interview with HCPLive during the Society for Pediatric Dermatology (SPD) 2024 Pre-AAD Meeting in San Diego, CA, this week, Peter A. Lio, MD, clinical assistant professor of dermatology at Northwestern Medicine Feinberg School of Medicine, discussed how to navigate potentially painful procedures in pediatric and adult dermatology patients alike. In today’s practice, so many moves a specialist makes can create an adverse patient experience: blood draws; biologic injections; biopsies; excisions; laser procedures and more.

“There's so many things that we do on a given day—even things as simple as freezing a wart, right?” Lio told HCPLive. “That's not a big deal for an adult, but for a kid, that can be a major traumatic event.”

Lio discussed the element of anxiety associated with painful dermatologic procedures—as well as the understood 3 aspects of pain mitigation that could help to resolve any negative associations with a specialist appointment:

Pain Control

“Can we do things to minimize the pain?” Lio explained. “This would include things like using a topical anesthetic—that's really helpful. Using an injected anesthetic, too, and doing it slowly and carefully, buffering at all these pieces. We talk about some of the different little pearls to make that as pleasant as possible when that's indicated.”

Attentional Strategies

“Can we remove their attention? Can we use distraction techniques?” Lio suggested. “It turns out talk therapy can do, that listening to music can do that, watching a movie can do that. But even better is something that engages them.”

Lio mentioned reading research suggesting that providing pediatric patients a video game to playing during in-office procedures was associated with a self-reported lack of pain on a scale similar to benzodiazepines: “It was unbelievable, it outperformed intense pharmacologic therapy.”

Altering Pain Perception

“These are things like using cooling therapy, using vibration—kind of taking advantage of this Gate (Control) Theory of Pain,” Lio said. “We can kind of put all these things together; we can use pharmacology to blunt the pain, we can use distraction techniques to remove their attention from it, and then we can do some of these other aspects to mitigate against the perception of the pain itself, which is really nice.”

While the approach may be catered to children, Lio believes it’s a practice appreciated by adult patients as well; he often hears from older patients that their anxiety over in-office procedures may be understated.

“It's just kind of that old trope— that kids aren't just little adults, but in some ways, adults are just big kids,” Lio said. “Obviously you're not infantilizing people, you're not talking down to them. But by being more open, being more gentle, I think some patients really respond to that.”