State and Future Science of Opioids and Potential of Biased-ligand Technology in the Management of Acute Pain After Burn Injury

Abstract

Pain associated with severe burn injury is one of the most intense and clinically challenging to manage, as the metabolic imbalances associated with the inflammation caused by the injury and treatment interventions (e.g., dressing changes and debridement, excision, and grafting) can further worsen the pain. In the pharmacologic management of a complex, hospitalized patient with burn injuries, opioid therapy remains an efficacious mainstay of treatment. However, the complex nature of pain, injury characteristics, and common demographics after burn injury place patients at high risk of opioid-related adverse events. Thus, guidelines recommend that decisions about choice of opioid be based on physiology, pharmacology, and physician experience, in addition to individualizing initial treatment with subsequent continual adjustments throughout care. Although substantial progress has been made in pain management strategies with utilization of non-opioid medications and nonpharmacologic adjuncts to opioid pharmacotherapy, there is still a need to evaluate new therapies, as an optimal regimen still lacks significant evidential support. Herein, we review the actions of opioids at the cellular level, contributing to both nociception and opioid-related adverse events. We also discuss the most recently approved intravenously administered opioid, oliceridine, developed utilizing biased ligand technology, including a summary of its clinical efficacy and safety in the management of severe acute pain. While oliceridine has been evaluated for the management of moderate-to-severe acute pain, the large phase 3 studies did not include patients with burn injuries. However, potential implications and future study direction for pain associated with burn injury are discussed.

Management of Pediatric Superficial Partial-Thickness Burns with Polyhexamethylene Biguanide: Outcomes and Influencing Factors

“…Evidence implies that effective pain and stress management enhances the process of pediatric burn reepithelialization and high pain levels hinder it [ 24 , 25 ]. Still, for example in the cases of frequently administered opioids, careful monitoring is necessary to ensure the prevention of side effects such as nausea, vomiting, respiratory depression, or reduced GI motility, resulting in anxiety or decreased mobility, that could prolong wound closure [ 26 , 27 ]. These observations prompt a deeper inquiry into the relationship between Hungarian pain management strategies and wound-healing processes in pediatric burn patients, to ensure, that the currently administered analgesics do not delay reepithelialization.…”

Pain Management in Pediatric Burns: A Review of the Science behind It

“…Opioids are typically administered intravenously or through patient-controlled analgesia (PCA) pumps to ensure adequate pain control. However, the use of opioids in pediatric burn patients requires careful monitoring due to the potential for side efects such as respiratory depression and sedation [48]. Terefore, healthcare providers must balance the need for pain relief with the potential risks associated with opioid use.…”