Pain inhibition in Q-switched laser tattoo removal with pneumatic skin flattening (PSF): a pilot study

Abstract

Background: Tattoo removal with a Q-switched laser is often a painful procedure. The sensation of pain associated with the treatment is immediate and acute. Application of topical anesthesia to the treated area of the skin is time-consuming, with only very moderate pain relief.

Objective: To determine the efficacy of pneumatic skin-flattening (PSF) technology which utilizes an evacuation chamber that generates skin compression and activates tactile neural receptors in the skin, resulting in afferent inhibition of pain transmission in the dorsal horn (the 'gate theory').

Methods: Eleven young patients aged 17-25 years old (nine females, two males) who were treated for tattoo removal were enrolled in the study. The patients were treated by a Q-switched Nd:YAG laser. Acute pain evaluation was performed on all 11 patients: one to two sites per patient with PSF and one to two control sites without PSF. When patients were treated with PSF, they knew they were being treated with a device that might reduce pain. This may have influenced patients' perception of pain. The evaluation was based on a modified McGill pain questionnaire.

Results: All 11 patients completed the study. A lower pain score with PSF was observed in all but one patient (10/11 or 91%). The average reduction of pain is by two levels: from very painful to very mild pain. The energy transmission of the PSF window is 95%, resulting in essentially identical efficacy of the PSF treatment and the regular non-PSF treatment.

Conclusion: This pilot study indicates that PSF technology may reduce pain in tattoo removal with medium energy density Q-switched lasers (3-5 J/cm(2)).