![]() ![]() Stimulation of local nociceptors transmits an impulse via Ad and C fibers to the dorsal horn of the spinal cord. At the time of burn injury, tissue damage is the primary mechanism of pain. Additionally, full thickness burns eventually require debridement and grafting and subsequent dressing changes which all lead to substantial pain. ![]() However, this does not always play out in clinical practice ( Choiniere M, 1989). While all burns are painful, conventionally, deeper, full thickness burns are thought to be somewhat less painful than superficial and partial thickness burns because of afferent nerve destruction ( Meyer WJ, 2012). As burn wounds begin to heal, neuropathic pain characterized by a throbbing or constant burning sensation potentially adds an additional layer of discomfort. Nociceptive pain is often followed by and potentially exacerbated by procedural pain related to the treatment of burn wounds, be it surgical debridement, grafting, staple application and removal, physical therapy, or dressing changes. The most immediate and acute form of burn pain is the inflammatory nociceptive pain attributed to burn injury and tissue trauma. Because individuals have varying pain thresholds, coping abilities and even physiologic responses to injury, patients may experience disparate levels of pain despite having similar injuries ( Faucher 2006). The individual experience of pain varies widely between patients and throughout the healing process in burn injuries ( Faucher 2006). While burns are classified according to depth, area and severity of injury, pain does not necessarily correlate with these measures. ![]() ![]() An overview of pain management strategies specific to the treatment of burn injuries is summarized here. The complex interaction of anatomic, physiologic, pharmacologic, psychosocial, and premorbid issues can make the treatment of burn pain particularly difficult. Instead, tradition and personal/institutional biases often dictate pain management. The unique challenge of burn pain is further complicated by a relative dearth of standardized approaches ( Faucher 2006). Without aggressive pain control, patients are likely to suffer not only from the acute experience of pain in itself, but the secondary morbidities of higher pain levels, including long-term anxiety and post-traumatic stress ( DR Patterson 1990, Saxe GN 2005) or even delayed wound healing ( Brown 2014). Good pain control is linked to better wound healing, sleep, participation in activities of daily living, quality of life and recovery ( Raymond 2004, Christian 2006).ĭespite profound improvements in modern burn care, suboptimal and inconsistent pain management persists throughout all stages of burn treatment. Therefore, pain management must be a foundation of burn care. These therapies can cause pain that is equivalent to or worse than the pain of an initial burn injury. The therapies used to treat burn injuries may exacerbate the difficulty of pain control because most of these interventions are associated with pain – be it dressing changes, excision and grafting, or physical therapy. In fact, some argue that burn pain is the most difficult to treat among any etiology of acute pain ( DR Patterson 2004). From the moment of injury through rehabilitation and beyond, pain control is a major challenge in the management of patients with burn injuries. ![]()
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