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Ice and topical anesthesia delivered essentially the same level of pain reduction following laser hair removal, according to findings published in .

The comparative-effectiveness study randomly assigned patients to receive a topical lidocaine-prilocaine mixture to one axilla and ice packs to the other before each of three monthly 810 nm diode laser sessions.

Among 88 laser treatments delivered, participants reported higher visual analog scale (VAS) pain scores immediately after laser treatment with lidocaine-prilocaine compared to ice (P=.03). Five minutes later, however, participants reported higher VAS scores with ice (P=.03). After 53 of the 88 treatments (60.2%), participants reported preferring ice (P=.055). No serious adverse events were reported.

Co-author Murad Alam, MD, MBA, is vice chair and chief of cutaneous and aesthetic surgery in the department of dermatology at Northwestern University Feinberg School of Medicine in Illinois. His discussion with the Reading Room has been edited for length and clarity.

What was the impetus for this study?

Alam: Laser hair removal is not a very, very painful treatment, but it's a little uncomfortable and some patients need more pain management than others. So the question was what can we do to best provide this pain management?

There are already approved medications -- topical agents that can provide pain relief for some length of time. But of course that means the patient needs to buy and apply the medication.

We also wondered: is there something really low cost and more or equally convenient that can be used if a patient doesn't have or doesn't want to use a topical anesthetic but still wants some pain relief? Our goal was to compare the effectiveness and to some extent the safety of using ice packs versus this topical mixture to reduce pain before laser hair removal.

How did the two methods compare?

Alam: The short answer is that pain reduction was about similar with ice and the topical mixture. With the topical mixture, pain scores were a little bit higher right after laser hair removal. But five minutes later, pain was a little bit higher with ice. Either way, there wasn't much of a difference, and patient satisfaction about equal.

We concluded that the topical mixture and ice were about equally effective -- at least in the way we used the topical mixture

Does the choice essentially hinge on patient preference?

Alam: Yes, it is somewhat a matter of patient preference. Overall numbers weren't different between the two, but some people liked one option and some liked the other.

So, one take-home message is that you could offer patients both options, see which one they liked, and then provide that choice in subsequent treatments.

What other advice would you have for clinicians on this front?

Alam: If you don't have the topical mixture available, ice isn't bad. You can use them more or less equally.

There are some issues with each option. With the topical mixture, you have to buy it. With ice, you have to acquire it, put it in a plastic bag, make sure that you don't use it for too long because you don't want to create an excessive cooling. In both cases, a little bit of common sense is needed.