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Burns pain
Acute Pain (2008) 10, 173—174
ABSTRACT
Burns pain Stephan A. Schug University of Western Australia and Royal Perth Hospital, Perth, WA, Australia Available online 23 September 2008
Burns pain presents a major problem in the management of acute pain. The treatment is complicated by the fact that burns pain is of nociceptive and/or neuropathic origin and exposes a variety of temporal patterns: constant background pain, intermittent movement-related pain and procedural pain. There is little evidence to guide the treatment of burns pain. Overall, intravenous administration of strong opioids via patient-controlled analgesia pumps is an effective treatment concept. Multimodal analgesia, combining opioids with adjuvants such as paracetamol and NSAIDs or COX-2 inhibitors, is a useful approach. Switching therapy to oral opioids when oral intake is possible is an effective long-term strategy. The treatment of procedure related pain is of extreme importance, in particular in patients undergoing dressing changes and debridements or participating in physiotherapy. Pharmacological approaches shown to be effective include intravenous titration of short-acting opioids and ketamine, administration of nitrous oxide and topical use of local anaesthetics. The provision of sedation can improve pain relief. Non-pharmacological approaches such as hypnosis and distraction or stimulation by touch, massage or electrical currents have also been tried. Overall, despite the obvious need for excellent analgesia in patients with burns injuries and/or undergoing procedures, there is little evidence in this area to support a best practice statement. Nevertheless, appropriate medications
and techniques are available and should be used appropriately. The effective treatment of acute burns pain is not only a humanitarian obligation, but might also prevent the development of chronic pain states, which are common in patients after burn injuries. Most of this persistent pain after burns injury is of neuropathic origin and requires multidisciplinary and multimodal management. In our own data, approximately 17% of patients reported experiencing chronic burn-related pain. Patients with burn-related chronic pain reported lower levels of satisfaction with acute pain medication, care received, and information provided compared to patients with no pain. Notably, patients with chronic burn-related pain reported higher levels of current psychological distress, and recalled higher levels of acute pain intensity when resting, engaging in physical activity, and during dressing changes compared to patients with no pain. Chronic burn-related pain is a significant problem among severely burned patients and appears to be related to higher levels of acute pain. Chronic pain is also associated with poorer acute treatment satisfaction.
Further readings [1] Montgomery RK. Pain management in burn injury. Crit Care Nurs Clin North Am 2004;16(1):39—49. [2] Abdi S, Zhou Y. Management of pain after burn injury. Curr Opin Anaesthesiol 2002;15(5):563—7.
1366-0071/$ — see front matter © 2008 Elsevier B.V. All rights reserved. doi:10.1016/j.acpain.2008.08.005
174
S.A. Schug
[3] Choiniere M. Burn pain: a unique challenge. Pain Clin Updates 2001;IX(1):1—4. [4] Linneman PK, Terry BE, Burd RS. The efficacy and safety of fentanyl for the management of severe procedural
pain in patients with burn injuries. J Burn Care Rehabil 2000;21(6):519—22. [5] Gallagher G, Rae CP, Kinsella J. Treatment of pain in severe burns. Am J Clin Dermatol 2000;1(6):329—35.
Available online at www.sciencedirect.com
ABSTRACT
Burns pain Stephan A. Schug University of Western Australia and Royal Perth Hospital, Perth, WA, Australia Available online 23 September 2008
Burns pain presents a major problem in the management of acute pain. The treatment is complicated by the fact that burns pain is of nociceptive and/or neuropathic origin and exposes a variety of temporal patterns: constant background pain, intermittent movement-related pain and procedural pain. There is little evidence to guide the treatment of burns pain. Overall, intravenous administration of strong opioids via patient-controlled analgesia pumps is an effective treatment concept. Multimodal analgesia, combining opioids with adjuvants such as paracetamol and NSAIDs or COX-2 inhibitors, is a useful approach. Switching therapy to oral opioids when oral intake is possible is an effective long-term strategy. The treatment of procedure related pain is of extreme importance, in particular in patients undergoing dressing changes and debridements or participating in physiotherapy. Pharmacological approaches shown to be effective include intravenous titration of short-acting opioids and ketamine, administration of nitrous oxide and topical use of local anaesthetics. The provision of sedation can improve pain relief. Non-pharmacological approaches such as hypnosis and distraction or stimulation by touch, massage or electrical currents have also been tried. Overall, despite the obvious need for excellent analgesia in patients with burns injuries and/or undergoing procedures, there is little evidence in this area to support a best practice statement. Nevertheless, appropriate medications
and techniques are available and should be used appropriately. The effective treatment of acute burns pain is not only a humanitarian obligation, but might also prevent the development of chronic pain states, which are common in patients after burn injuries. Most of this persistent pain after burns injury is of neuropathic origin and requires multidisciplinary and multimodal management. In our own data, approximately 17% of patients reported experiencing chronic burn-related pain. Patients with burn-related chronic pain reported lower levels of satisfaction with acute pain medication, care received, and information provided compared to patients with no pain. Notably, patients with chronic burn-related pain reported higher levels of current psychological distress, and recalled higher levels of acute pain intensity when resting, engaging in physical activity, and during dressing changes compared to patients with no pain. Chronic burn-related pain is a significant problem among severely burned patients and appears to be related to higher levels of acute pain. Chronic pain is also associated with poorer acute treatment satisfaction.
Further readings [1] Montgomery RK. Pain management in burn injury. Crit Care Nurs Clin North Am 2004;16(1):39—49. [2] Abdi S, Zhou Y. Management of pain after burn injury. Curr Opin Anaesthesiol 2002;15(5):563—7.
1366-0071/$ — see front matter © 2008 Elsevier B.V. All rights reserved. doi:10.1016/j.acpain.2008.08.005
174
S.A. Schug
[3] Choiniere M. Burn pain: a unique challenge. Pain Clin Updates 2001;IX(1):1—4. [4] Linneman PK, Terry BE, Burd RS. The efficacy and safety of fentanyl for the management of severe procedural
pain in patients with burn injuries. J Burn Care Rehabil 2000;21(6):519—22. [5] Gallagher G, Rae CP, Kinsella J. Treatment of pain in severe burns. Am J Clin Dermatol 2000;1(6):329—35.
Available online at www.sciencedirect.com