Pain and the Thermally Injured Patient—A Review of Current Therapies

Abstract

Thermally injured patients experience tremendous pain from the moment of injury to months or years after their discharge from the hospital. Pain is therefore a critical component of proper management of burns. Although the importance of pain is well recognized, it is often undertreated. Acute uncontrolled pain has been shown to increase the incidence of mental health disorders and increase the incidence of suicide after discharge. Long-term poor pain control leads to an increase in the incidence of persistent pain. Most burn centers have used opioids as the mainstay analgesic, but recently, the significant side effects of opioids have led to the implementation of new and combined therapeutics. Pharmacological agents such as gabapentin, clonidine, dexmedetomidine, and ketamine have all been suggested as adjuncts to opioids in the treatment of burn pain. Nonpharmacological therapies such as hypnosis, virtual reality devices, and behavioral therapy are also essential adjuncts to current medications. This review aims at identifying the currently available pharmacological and nonpharmacological options for optimal pain management in the adult burn population.

Pain and itch outcome trajectories differ among European American and African American survivors of major thermal burn injury

“…Of note, 75% (53/71) of study participants received opioids without any other adjunctive analgesic medications. Multimodal analgesia has been shown to reduce opioid use and improve pain and functional outcomes in other settings [6; 16], has been advocated for MThBI survivors[49]. Further studies are needed to evaluate the utility of multimodal analgesia and identify novel non-opioid treatment options for MThBI survivors experiencing moderate or severe pain.…”

Sedation, Analgesia Delirium in the ECMO Patient

“…Additionally, the benefits of acetaminophen may not be as apparent or relevant in a population that requires long-term ICU level care. Neuropathic pain in settings such as burns, neuralgia, and neuropathy tends to be poorly treated by opioids [1]; however, it may respond to medications such as gabapentin and pregabalin that target calcium channels in the central nervous system [6,20]. If patients have been started on these medications due to pre-existing conditions, continuation of the therapy is prudent to avoid withdrawal.…”

Role of the NLRP3 inflammasome in a model of acute burn-induced pain

“…This is clinically relevant, as stimulus-evoked pain may 19 reflect pain related to dressing changes, baths and debridement, which often reaches 20 quite intense levels and is difficult to manage in burns patients [19]. Similar results 21 have been found in other pain models, with mechanical and thermal allodynia 22 developing normally in Nlrp3 -/-mice following spared nerve injury and no reduction 23 in spontaneous pain behaviours in Nlrp3 -/-mice following formalin injection [17].…”