Does It Hurt?

Recent data from the University of Michigan indicate that variations in a certain gene are predictors of low pain tolerance. That gene, which comes in two forms, makes an enzyme called COMT that helps control the brain signals involved in pain response. And researchers at McGill University in Montreal have identified a gene that is linked to both red hair color and higher levels of pain tolerance. But individual response to laser procedures varies, and you may be more comfortable if you observe a few precautions:

• Remain calm. Stress, with its attendant adrenaline rush, acts on pain-sensing neurons called nociceptors and can exacerbate pain.
• Consult your pharmacist. Some medications that increase the level of adrenaline in the bloodstream, such as those for asthma and glaucoma, can lower pain tolerance.
• Skip Starbucks. Stimulants such as caffeine and sugar may increase pain sensitivity.
• Check the calendar. Many women find treatment more painful before or during their periods.
• Know your tender spots. The sides of the nose, the orbital area, and the inner thighs are often the most sensitive places on the body in regard to laser treatments.
• Expect serendipity. "I've had three Fraxel treatments myself," says Richard Fitzpatrick, M.D., of the LaJolla Cosmetic Surgery Centre. "On a pain scale of 1 to 10, my first treatment was a 1 or 2; my second treatment was more of a 7 or 8; the third was about a 4." He doesn't know why.
• This one hurts. The carbon-dioxide laser is in a class by itself when it comes to pain, as it strips away the outer layers of skin. It is best used under general anesthesic. "We used to do it with a local or nerve block," says Dr. Fitzpatrick. "By the end of the treatment, the patient was crying, the nurse was crying, and the doctor was crying."
• These, not so much. The other types of laser cause a sensation that is often described as similar to having a rubber band snapped against the skin. "To me, it feels more like a splatter of hot grease," says Dr. Fitzpatrick. "The pain is markedly diminished by using a cold air blower and topical anesthetic. It may hurt like a really bad sunburn after treatment, but if it lasts more than three to six hours after laser resurfacing, it means something's wrong. I'm a big believer in the 'no pain, no gain' theory. I don't think there's anything we do that works significantly without some degree of pain."