71 Treatment for Chronic-Burn Induced Neuropathy: A Systematic Review and Meta-Analysis

Abstract

Introduction Effective management of chronic burn-induced neuropathy manifesting as pain and/or pruritus presents an ongoing challenge for clinicians. Standards of care are based on limited evidence and vary widely, especially for non-surgical neuropathies that are not associated with a specific nerve distribution. This study aims to quantify and qualify evidence for non-surgical treatments of chronic burn-induced neuropathy to define their efficacy. Methods PRISMA and Cochrane guidelines were implemented for review structure. PubMed, Science Direct, Embase, Cochrane Library, and Web of Science databases were searched for relevant studies. Inclusion criteria were patients age 18 years and older, with neuropathy lasting >6 months following burn injury. Studies for inclusion were comparative intervention studies for treatments of chronic burn-induced neuropathies. Mean differences (MD) between interventions eligible for meta-analysis were analyzed for neuropathy outcomes. Results Seventeen randomized controlled trials (RCTs) were identified for inclusion with a mean post-burn follow-up of 20.8±39.3 months. Nine studies reported pain and sixteen reported pruritus using patient reported visual analogue scales for 601 and 975 patients, respectively. Pain interventions included transcranial direct current stimulation (tDCS), extracorporeal shockwave therapy (EWST), massage therapy, carbon dioxide (CO2) laser, silicone gel, and pressure therapy. Pruritus interventions included tDCS, ESWT, massage, herbal cream, doxepin cream, enzymatic moisturizer, CO2 laser, silicone gel, and pressure therapy. CO2 laser showed no improvement over standard care for the treatment of pain or pruritus associated with hypertrophic scarring (pain: MD 0.26, 95%CI -0.04, 0.57; p=0.09; pruritus: MD -0.07, 95%CI -0.44, 0.30; p=0.72). ESWT showed no statistically significant improvement over standard care for the treatment of pruritus (MD -2.69, 95%CI -5.42, 0.04; p=0.05). Massage therapy was associated with significantly greater improvements in pruritus than standard care (MD -1.64, 95%CI -2.10, -1.09; p< 0.00001). Doxepin cream was not associated with greater improvements in pruritus than placebo or antihistamines (MD -0.84, 95%CI -3.61, 1.94; p=0.56). Conclusions Creative efforts have revealed massage therapy as a potential non-surgical intervention for treating chronic burn-induced neuropathy. Additional RCTs with innovative non-surgical interventions will provide further insights for this challenging condition.