Pain Management in Burn Patients

Castro, Rodrigo José Alencar de; Leal, Plínio da Cunha; Sakata, Rioko Kimiko

doi:10.1016/s0034-7094(13)70206-x

Cited by 41 publications

(9 citation statements)

References 46 publications

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“…The various dimensions of pain intensity are associated with different areas of the pain network. Changes in the pain and motor network have been observed when chronic pain occurs in burn patients [ 29 ]. The treatment mechanism of ST is known to inhibit pain by stimulating C fibers of afferent pathways with five artificial electrical stimulation and blocking the pathways of pain information [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…Many studies of non-invasive brain-modulatory therapy have demonstrated a relationship between changes in the cerebral pain network and pain intensity. This pain network consists of the primary and secondary somatosensory cortex, the prefrontal lobe, dorsolateral prefrontal cortex, and medial prefrontal cortex [ 29 ]. Neuroimaging studies indicate that the dorsolateral prefrontal cortex may play a role in a top-down mode of inhibition via fibers descending from the prefrontal cortex, which may modulate pain perception.…”

Section: Discussionmentioning

confidence: 99%

“…All MRIs were performed using a 3.0 T magnetic resonance scanner (MAGNETOM Skyra, Siemens; Erlangen, Germany) and an established steady-state gadolinium-enhanced MRI technique [ 18 , 29 ]. Two high-resolution T1-weighted images were acquired for each participant: one before a standard intravenous administration of gadolinium contrast agent (0.1 mmol/kg gadoterate meglumine) and the second at 4 min after the gadolinium administration.…”

Section: Methodsmentioning

confidence: 99%

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Scrambler Therapy for Chronic Pain after Burns and Its Effect on the Cerebral Pain Network: A Prospective, Double-Blinded, Randomized Controlled Trial

Lee

Park

Cho

et al. 2022

JCM

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Chronic pain is common after burn injuries, and post-burn neuropathic pain is the most important complication that is difficult to treat. Scrambler therapy (ST) is a non-invasive modality that uses patient-specific electrocutaneous nerve stimulation and is an effective treatment for many chronic pain disorders. This study used magnetic resonance imaging (MRI) to evaluate the pain network-related mechanisms that underlie the clinical effect of ST in patients with chronic burn-related pain. This prospective, double-blinded, randomized controlled trial (ClinicalTrials.gov: NCT03865693) enrolled 43 patients who were experiencing chronic neuropathic pain after unilateral burn injuries. The patients had moderate or greater chronic pain (a visual analogue scale (VAS) score of ≥5), despite treatment using gabapentin and other physical modalities, and were randomized 1:1 to receive real or sham ST sessions. The ST was performed using the MC5-A Calmare device for ten 45 min sessions (Monday to Friday for 2 weeks). Baseline and post-treatment parameters were evaluated subjectively using the VAS score for pain and the Hamilton Depression Rating Scale; MRI was performed to identify objective central nervous system changes by measuring the cerebral blood volume (CBV). After 10 ST sessions (two weeks), the treatment group exhibited a significant reduction in pain relative to the sham group. Furthermore, relative to the pre-ST findings, the post-ST MRI evaluations revealed significantly decreased CBV in the orbito-frontal gyrus, middle frontal gyrus, superior frontal gyrus, and gyrus rectus. In addition, the CBV was increased in the precentral gyrus and postcentral gyrus of the hemisphere associated with the burned limb in the ST group, as compared with the CBV of the sham group. Thus, a clinical effect from ST on burn pain was observed after 2 weeks, and a potential mechanism for the treatment effect was identified. These findings suggest that ST may be an alternative strategy for managing chronic pain in burn patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Scrambler Therapy for Chronic Pain after Burns and Its Effect on the Cerebral Pain Network: A Prospective, Double-Blinded, Randomized Controlled Trial

Lee

Park

Cho

et al. 2022

JCM

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“…Along with initial pain, there may be incidental pain with significant severity variation, leading to changes in analgesic requirements. 4 In the acute phase, it is estimated that 84% of patients experience severe to intolerable pain, 100% report daily pain, and 92% suffer night pain that awakens them. 5 …”

Section: Introductionmentioning

confidence: 99%

Efficacy of opioids and non-opioid analgesics in the treatment of post procedure pain of burned patients: a narrative review

Chinchilla

Moyano

2022

Brazilian Journal of Anesthesiology (English Edition)

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“…Acute stress disorder, post-traumatic stress disorder, chronic pain and depression are highly prevalent among survivors of severe burns (1). Anesthetic management may modulate this physiological response and impact post-operative recovery.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of dexmedetomidine in reducing post‑operative pain and improving the quality of recovery in patients with burn wounds undergoing tangential excision skin grafting

et al. 2019

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Burn-induced acute post-operative pain and the associated stress response may result in prolonged convalescence. The present study investigated the effects of dexmedetomidine (DEX) administration on post-operative pain and the quality of recovery following surgical treatment of moderate-to-severe burn injuries. A total of 60 adult patients undergoing tangential excision skin grafting were randomized into two groups. The DEX group (Group D) received an intravenous (i.v.) single-dose bolus injection of DEX 0.5 µg/kg >10 min prior to induction of anesthesia. Patient-controlled intravenous analgesia (PCIA) was provided to the patients from the end of the surgery, which consisted of 100 µg sufentanil plus 200 µg DEX. The control group (Group C) received an equal volume of normal saline as a pre-operative bolus and post-operative PCIA of 100 µg sufentanil infusion. The Visual Analogue Scale (VAS) score at rest and during movement, the cumulative dose of sufentanil and the 40-item quality of recovery questionnaire (QoR-40) score were assessed at various time-points after the surgery. During the first 24 h post-surgery, patients in Group D exhibited a lower VAS score at rest and during movement, a lower number of PCIA pump presses (29.17±1.91 vs. 34.13±2.73) and lower sufentanil consumption (62.58±0.96 vs. 65.27±1.26) compared with those in Group C (P<0.05). Furthermore, the QoR-40 recovery score of patients in Group D at 24 h post-surgery was higher compared with that in Group C (P<0.01). In conclusion, the present study indicated that a pre-operative bolus of DEX (0.5 µg/kg) followed by DEX plus sufentanil by PCIA subsequent to surgery improved the quality of analgesia and promoted the quality of recovery at 24 h following tangential excision skin grafting treatment of patients with moderate-to-severe burn injuries compared to PCIA of 100 µg sufentanil only. The present study was retrospectively registered with the trial registration no. ChiCTR1800016646 (date of registration, 14/06/2018).

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Pain Management in Burn Patients

Cited by 41 publications

References 46 publications

Scrambler Therapy for Chronic Pain after Burns and Its Effect on the Cerebral Pain Network: A Prospective, Double-Blinded, Randomized Controlled Trial

Scrambler Therapy for Chronic Pain after Burns and Its Effect on the Cerebral Pain Network: A Prospective, Double-Blinded, Randomized Controlled Trial

Efficacy of opioids and non-opioid analgesics in the treatment of post procedure pain of burned patients: a narrative review

Efficacy of dexmedetomidine in reducing post‑operative pain and improving the quality of recovery in patients with burn wounds undergoing tangential excision skin grafting

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