Principles of Burn Pain Management

James, Dominika Lipowska; Jowza, Maryam

doi:10.1016/j.cps.2017.05.005

Cited by 56 publications

(38 citation statements)

References 51 publications

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“…26,44,47–49 Blocking COX activity by anti-inflammatory drugs reduces prostaglandin production, thereby minimizing both peripheral and central sensitization, which leads to reduction of inflammatory pain. 21,26,29 Moreover, peripheral inflammatory processes may cause central sensitization with upregulation of nociceptive processes, 28 which are relatively long-lasting; however, these processes are reversible and will disappear upon resolution of the inflammatory process. 13,50…”

Section: Inflammatory Painmentioning

confidence: 99%

“…13,18,19 Inflammatory pain is best treated with paracetamol, aspirin, or other nonsteroidal anti-inflammatory drugs (NSAIDs) and—when necessary—by opioids; in contrast, chronic pain is typically treated with either tricyclic antidepressants (e.g., amitriptyline) or anticonvulsants (e.g., gabapentin), or a combination of the two. 12,20–23…”

Section: Introductionmentioning

confidence: 99%

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Selected pathobiological features and principles of pharmacological pain management

et al. 2020

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Pain induced by inflammation and nerve injury arises from abnormal neural activity of primary afferent nociceptors in response to tissue damage, which causes long-term elevation of the sensitivity and responsiveness of spinal cord neurons. Inflammatory pain typically resolves following resolution of inflammation; however, nerve injury—either peripheral or central—may cause persistent neuropathic pain, which frequently manifests as hyperalgesia or allodynia. Neuralgias, malignant metastatic bone disease, and diabetic neuropathy are some of the conditions associated with severe, often unremitting chronic pain that is both physically and psychologically debilitating or disabling. Therefore, optimal pain management for patients with chronic neuropathic pain requires a multimodal approach that comprises pharmacological and psychological interventions. Non-opioid analgesics (e.g., paracetamol, aspirin, or other non-steroidal anti-inflammatory drugs) are first-line agents used in the treatment of mild-to-moderate acute pain, while opioids of increasing potency are indicated for the treatment of persistent, moderate-to-severe inflammatory pain. N-methyl D-aspartate receptor antagonists, antidepressants, anticonvulsants, or a combination of these should be considered for the treatment of chronic neuropathic pain. This review discusses the various neural signals that mediate acute and chronic pain, as well as the general principles of pain management.

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Section: Inflammatory Painmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Selected pathobiological features and principles of pharmacological pain management

et al. 2020

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“…In our opinion, especially in the burn population, one of the main advantages is the non-pharmacological nature of tES. While opioids remain the cornerstone of pain management in the burn population [115]; given the risk of addiction, alternatives to pharmacological treatment are necessitated. tES represents a safe, inexpensive, and well tolerated modality as compared to other treatment strategies [116].…”

Section: Discussionmentioning

confidence: 99%

A review of burn symptoms and potential novel neural targets for non-invasive brain stimulation for treatment of burn sequelae

Thibaut

Shie

Ryan

et al. 2021

Burns

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Burn survivors experience myriad associated symptoms such as pain, pruritus, fatigue, impaired motor strength, post-traumatic stress, depression, anxiety, and sleep disturbance. Many of these symptoms are common and remain chronic, despite current standard of care. One potential novel intervention to target these post burn symptoms is transcranial direct current stimulation (tDCS). tDCS is a non-invasive brain stimulation (NIBS) technique that modulates neural excitability of a specific target or neural network. The aim of this work is to review the neural circuits of the aforementioned clinical sequelae associated with burn injuries and to provide a scientific rationale for specific NIBS targets that can potentially treat these conditions. We ran a systematic review, following the PRISMA statement, of tDCS effects on burn symptoms. Only three studies matched our criteria. One was a feasibility study assessing cortical plasticity in chronic neuropathic pain following burn injury, one looked at the effects of tDCS to reduce pain anxiety during burn wound care, and one assessed the effects of tDCS to manage pain and pruritus in burn survivors. Current literature on NIBS in burn remains limited, only a few trials have been conducted. Based on our review and results in other populations suffering from similar symptoms as patients with burn injuries, three main areas were selected: the prefrontal region, the parietal area and the motor cortex. Based on the importance of the prefrontal cortex in the emotional component of pain and its implication in various psychosocial symptoms, targeting this region may represent the most promising target. Our review of the neural circuitry involved in post burn symptoms and suggested targeted areas for stimulation provide a spring board for future study initiatives.

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“…The current standard of care in pain management involves a multimodal strategy using pharmacological and non-pharmacological medications and techniques [ 2 , 3 ]. Since the onset of the opioid crisis, many clinicians, health systems and regulatory agencies have sought to limit opioid use and dependency [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Techniques and strategies for regional anesthesia in acute burn care—a narrative review

et al. 2021

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Burn injuries and their treatments result in severe pain. Unlike traumatic injuries that are characterized by a discrete episode of pain followed by recovery, burn-injured patients endure pain for a prolonged period that lasts through wound closure (e.g. background pain, procedural pain, breakthrough pain, neuropathic pain and itch). Regional anesthesia, including peripheral nerve blocks and neuraxial/epidural anesthesia, offers significant benefits to a multimodal approach in pain treatment. A ‘regional-first’ approach to pain management can be incorporated into the workflow of burn centers through engaging regional anesthesiologists and pain medicine practitioners in the care of burn patients. A detailed understanding of peripheral nerve anatomy frames the burn clinician’s perspective when considering a peripheral nerve block/catheter. The infra/supraclavicular nerve block provides excellent coverage for the upper extremity, while the trunk can be covered with a variety of blocks including erector spinae plane and quadratus lumborum plane blocks. The lower extremity is targeted with fascia iliaca plane and sciatic nerve blocks for both donor and recipient sites. Burn centers that adopt regional anesthesia should be aware of potential complications and contraindications to prevent adverse events, including management of local anesthetic toxicity and epidural infections. Management of anticoagulation around regional anesthesia placement is crucial to prevent hematoma and nerve damage. Ultimately, regional anesthesia can facilitate a better patient experience and allow for early therapy and mobility goals that are hallmarks of burn care and rehabilitation.

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Principles of Burn Pain Management

Cited by 56 publications

References 51 publications

Selected pathobiological features and principles of pharmacological pain management

Selected pathobiological features and principles of pharmacological pain management

A review of burn symptoms and potential novel neural targets for non-invasive brain stimulation for treatment of burn sequelae

Techniques and strategies for regional anesthesia in acute burn care—a narrative review

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