Neuropathic agents in the management of pruritus in burn injuries: a systematic review and meta-analysis

McGovern, C., Quasim, T. , Puxty, K. , Shaw, M., Ng, W., Gilhooly, C. , Arkoulis, N., Basler, M., MacFarlane, A. and Paton, L. (2021) Neuropathic agents in the management of pruritus in burn injuries: a systematic review and meta-analysis. Trauma Surgery and Acute Care Open, 6(1), e000810. (doi: 10.1136/tsaco-2021-000810)

Abstract

Objectives: Pruritus is a common and often distressing complication after a burn injury. The purpose of this review is to explore the efficacy of drugs classically used to treat neuropathic pain in the management of pruritus after burn injury. Methods: A systematic literature search of medical databases was conducted to find studies investigating drugs listed in the National Institute for Health and Care Excellence (NICE) guideline (CG173, “neuropathic pain in adults”) for the management of pruritus after burn injury in patients of any age. Controlled studies were stratified by the drug class studied and their risk of bias before conducting meta-analysis. A narrative review of case series or observational studies was presented. Severity of pruritus at any time point, with all quantitative and qualitative measures, was included. Results: Fifteen studies were included in the final analysis, 10 investigated the use of gabapentinoids, 4 studied doxepin, and 1 local anesthetic agents. Meta-analysis of three randomized controlled trials (RCTs) demonstrated that the use of gabapentinoids was associated with an improvement in mean VAS (Visual Analog Scale) 0–10 scores of 2.96 (95% confidence interval (95% CI) 1.20 to 4.73, p<0.001) when compared with placebo or antihistamine. A meta-analysis of four RCTs investigating topical doxepin showed an improvement in mean VAS scores of 1.82 (95% CI 0.55 to 3.09, p<0.001). However, when excluding two studies found to be at high risk of bias, no such improvement was found (−0.32, 95% CI −1.64 to –0.99, p=0.83). Conclusion: This study suggests that gabapentinoids are beneficial in the management of burn-related pruritus. There is a lack of evidence to suggest that doxepin is an effective treatment. Topical local anesthetic agents may be safe and beneficial, but studies are scarce.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Arkoulis, Dr Nikolaos and MacFarlane, Dr Alan and Puxty, Dr Kathryn and McGovern, Dr Christopher and Quasim, Professor Tara and Paton, Dr Lia and Shaw, Dr Martin and Gilhooly, Dr Charlotte
• Authors: McGovern, C., Quasim, T., Puxty, K., Shaw, M., Ng, W., Gilhooly, C., Arkoulis, N., Basler, M., MacFarlane, A., and Paton, L.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Trauma Surgery and Acute Care Open
• Publisher: BMJ Publishing Group
• ISSN: 2397-5776
• ISSN (Online): 2397-5776
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in Trauma Surgery and Acute Care Open 6(1):e000810
• Publisher Policy: Reproduced under a Creative Commons licence