BURN PAIN

Initial pain from a burn results from the body’s response to tissue damage.
Pain fibers (nociceptors) and chemicals involved in the inflammatory
response signal that an injury has occurred. These chemicals also promote
healing.

Lingering Pain
During the healing process, pain persists because newly formed
tissues and nerves are hypersensitive. Severe burns damage nerves
and may cause large areas of hypersensitivity in and around the
burn wound. Such stimulation leads to greater pain sensitivity and a
high risk of persistent, neuropathic pain even after the burn has
healed.

What to look for

Burns cause excruciating pain. The deeper the burn, the more
extensive the damage to nerve tissue – and the more intense the
pain.

Patients typically describe burn pain as aching or burning. Some

patients also have neuropathic pain (such as paresthesia),
sensations of numbness or burning, or shooting pains.

Painful cures
Unfortunately, the procedures the burn patient must undergo to
promote healing and rehabilitation – dressing changes,
debridement, physical therapy, skin grafting, and reconstructive
surgery – can also cause severe pain.

Assessing burn pain

Make every effort to perform a comprehensive pain assessment.
Have the patient rate his pain intensity on a pain rating scale.

Keep in mind that burn severity is determined by the depth and

extent of the burn and the presence of other factors, such as age,
complications, and co-existing illnesses.

It gets complicated
Assessing burn patients can pose a challengee because these
patients have complex physical and emotional needs. For instance,
some patients may be too upset to cooperate because of traumatic
memories of the incident, being in a strange environment, or fear of
painful treatments and procedures. Also, young children and infants
may be unable to verbalize pain severity.

Managing burn pain

Poor pain management can hamper recovery from a burn. The
injury causes a stress response that triggers catecholamine release,
in turn worsening the hypermetabolism (increased energy
expenditure) that follows a serious burn.
 Hypermetabolism decreases blood flow to the skin and soft tissues,
impairing wound healing. At the same time, excessive pain triggers
release of endogenous endorphins, possibly leading to
hemodynamic instability and immunosuppression.
High anxiety
Pain relief is a priority and should begin immediately. Untreated
pain is hard to control and may cause a conditioned anxiety
response. Effective pain relief also reduces the risk of posttraumatic
stress disorder.

Analgesic analysis
The analgesic type, dose, and administration route depend on pain
severity and frequency (constant or intermittent). Morphine and
hydromorphone are the drugs of choice (usually given using a PCA
infusion pump) for patients who can’t tolerate oral intake.

In a patient who can tolerate oral intake, controlled-released

morphine or oxycodone may be given orally to relieve constant
moderate to severe pain.

Try to give analgesics as painlessly as possible. Avoid injections

because they may cause pain and unpredictable drug absorption.

Adjuvant action
Quick, short-acting I.V. fentanyl or remifentanil may be used to
control intense pain of short duration, such as procedural pain.
Adjuvant drugs, such as clonidine and anticonvulsants, may be
useful for neuropathic pain associated with burns.

Benzodiazepines help reduce anxiety. Neuroleptics may be

prescribed to treat intensive care psychosis, a psychological
condition associated with serious burns.

Dress for less pain

Dressings and creams promote healing and pain relief. Biocclusive
dressings have an analgesic effect, protecting the area from
inadvertent touch and breezes and decreasing the need for
debridement.

Sulfadiazine (silvadene) cream is an antimicrobial agent used to

treat severe burns. Researchers have infused this cream with
morphine in an attempt to reduce burn pain. Another option is to
apply local anesthetics to burn sites.

Inhalation anesthetics may be used during dressing changes,

debridement, skin grafting, and reconstructive surgery. Nitrous
oxide is sometimes used for minor procedures.

A spell on pail
Nonpharmacologic pain management techniques, such as hypnosis
and relaxation techniques, may be helpful for some burn patients.