Diagnosis and treatment of inhalation injury

Pain, anxiety and itching are inter-related symptoms of burn injury and effective control of each requires attention to all three. Poor control of pain and itching enhances anxiety, impairs compliance with therapies, increases physiological stress, slows healing, and increases the risk of chronic pain syndromes and psychiatric morbidity such as post-traumatic stress disorder. Anxiolytic medications enhance analgesics. Theoretical advances in understanding the physiology of pain have allowed improved pain control through application of multimodal strategies that take advantage of synergistic non-opiate therapies and medications. Standardized tools are available to quantitate pain and judge the effectiveness of therapy. Burn pain is classified as background, break through, procedural, and post-operative pain. Each type has unique features in terms of quality, intensity, and duration that require different treatment strategies. Intense itching complicates healing wounds as a significant source of suffering and a risk of graft loss. Effective pain control requires vigilance and flexibility to individualize care.