Pain is the most common therapeutic response in photodynamic therapy, and studies have shown that nearly half of patients require pain management. The mechanism of pain treatment with ALA-PDT is still unclear, and the influencing factors include individual characteristics, lesion characteristics and treatment parameters (light source, photosensitizer, temperature, time, light dose and frequency). Clinical strategies include: local hypothermia, oral analgesics, two-step photoluminescence, anesthesia (surface anesthesia, injectable anesthesia, inhalational anesthesia), transcutaneous electrical nerve stimulation, and hypnosis, etc. The principle of clinical selection is to ensure efficacy with simplicity and ease of use. For mild pain, we recommend local cooling, oral analgesics, or adjusting the way the device is illuminated, such as slowly moving the light source away from the lesion and then moving it closer after the patient has adapted. For moderate pain, oral analgesics or a two-step illumination method is recommended, such as: adjusting the power density by adjusting the power density downward by 20%, while extending the treatment time to 30 minutes. For severe pain, local infiltration anesthesia or nerve block anesthesia is recommended, e.g., local lidocaine spray or local lidocaine injection can be used before treatment, and then illumination is performed 5-10 minutes later.