Management of Pain and Other Discomforts in Burned Patients

Although a multidisciplinary approach including nonpharmacological modes of management are essential, pharmacological treatment remains the cornerstone of pain control in patients with burn injuries. Drug and dose selection must be made in the context of systemic changes that evolve over time and alter pharmacokinetics and pharmacodynamics. Opioids are the mainstay of therapy but are associated with certain adverse effects such as opiate induced hyperalgesia. A newly appreciated problem. neuropathic pain, is characterized by burning and itching in the areas of newly regenerating skin and at amputation site. Effective pharmacological analgesia requires the concomitant treatment of anxiety, depression and PTSD with anxiolytics and antidepressants to control the pain syndrome following burn injury. Pain protocols facilitate the systematic pain management. New non pharmacologic approaches such as virtual reality now have demonstrated effectiveness. Burn pain comprises background, breakthrough, procedural and postoperative pain. Each type of pain requires different drugs, doses, or strategies.