Back pain after photodynamic therapy with verteporfin

PURPOSE: To report the incidence of back pain after photodynamic therapy, which suggests methods for prevention that are related to its pathogenesis. DESIGN: Retrospective case series. METHODS: We retrospectively observed 548 patients who had undergone photodynamic therapy with verteporfin. RESULTS: Of 548 patients at the first treatment, 14 patients (2.6%) experienced pain during the infusion. Eleven patients were being treated for age-related macular degeneration; their mean age was 81 years, which significantly differed from the mean age of the overall age-related macular degeneration group (P = .003). The pain was mild in eight patients, moderate in four patients, and severe in two patients, with dyspnea and precordial pain. Five of the 14 patients had further courses of photodynamic therapy. After being treated prophylactically 60 minutes before photodynamic therapy, only one patient reported further mild pain. CONCLUSIONS: The biologic mechanisms of back pain may involve a high level of circulating thromboxanes that are induced by the liposomal composition of verteporfin. Prevention may include hydration, nonsteroidal anti-inflammatory drugs, and halving the infusion rate.