Treatment of pain in severe burns

Gallagher, G., Rae, C. P. and Kinsella, J. (2000) Treatment of pain in severe burns. American Journal of Clinical Dermatology, 1(6), pp. 329-335. (doi: 10.2165/00128071-200001060-00001) (PMID:11702609)

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Burn pain can cause psychologic and functional difficulties, and is difficult to predict from wound depth. The initial painful stimulation of nerve endings by the burn with continued painful stimuli result in peripheral and central mechanisms causing amplification of painful stimuli, and the development of chronic pain syndromes that can be difficult to treat. In order to assess the effect of analgesic interventions it is essential to measure the patient’s pain in a simple and reproducible manner. A number of tools exist for this measurement, ranging from longer and more detailed techniques such as the McGill pain questionnaire most suited to relatively stable pain, to visual analogue scores and picture-based scores for children. Pain management begins with the acute injury, with initial measures such as cooling of the burn and use of inhalational agents such as oxygen/nitrous oxide mixtures. On arrival in hospital, for any but trivial burns, intravenous opioids are appropriate and should be administered as small intravenous boluses titrated against effect. Following the initial resuscitation, pain may be divided into background pain and that associated with procedures. These often require different analgesic interventions. Background pain may be treated with potent intravenous opioids by infusion or patient controlled analgesia and then on to oral, less potent opioids, followed by other oral analgesics. Often drug combinations work best. More severe procedural pain may be treated with a variety of interventions from a slight increase in therapy for the background pain to more potent drugs, local blocks, or general anaesthesia. In addition to drug-based methods of managing burn pain, a number of nonpharmacologic approaches have been successfully employed including hypnosis, auricular electrical stimulation, massage, and a number of cognitive and behavioural techniques. The pain following severe burns is unpredictable and may persist for over a year after the burn has healed. Pain may continue to cause impairment of function and can lead to psychological problems, and should be treated aggressively. In this article the mechanisms involved in the pain caused by burns will be discussed, followed by the current methods of treatment.

Item Type:Articles (Other)
Glasgow Author(s) Enlighten ID:Kinsella, Professor John
Authors: Gallagher, G., Rae, C. P., and Kinsella, J.
Subjects:R Medicine > R Medicine (General)
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:American Journal of Clinical Dermatology
Publisher:Springer Verlag
ISSN (Online):1179-1888

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