Pain Management in Burn Injuries

Introduction: Burn injuries are a significant problem with more than 500000 people seeking medical treatment, 40000 hospitalization and 4000 deaths per year in the united States. Annually about 30000 sever burns and 3000 deaths occur in Iran.Pain is one of the major challenges in burn injuries. If we could control pain ,patients have better outcome in wound healing, sleep,participation in daily activities and recovery. Ultimately it can effect quality of life.Pain is individual and patients have different pain thresholds.Inflammatory nociceptive pain is the most acute form of pain related to tissue trauma and burn that can exacerbated by procedures such as dressing changes,excision and grafting and physical therapy. when wounds begin to heal neuropathic pain presented by constant burning sensation. Superficial and partial thickness burns are very painfull because of nerve ending stimulation by pressure, air and movement. Full thickness burns are less painful because of nerve destruction but they can cause substantial pain after debridement ,grafting and dressing. background pain present while the patient is at rest result from thermal injury that has low to moderate intensity with long duratioin.Chronic pain last longer than six months or remain after healing of wound or skin grafts . the most common type of chronic pain is neuropathic pain.Verbal adjective,Numeric and visual analoge scales used for burn assessment.Oral NSAIDS and acetaminophen usually used in the out patient.For hospitalized patients ,opioids are the drugs of choice. Anixety and agitation are other problems that in this regard anxiolytic and antipsychotic and anesthetics medications can used. Nonpharmacological approaches such as Hypnosis,cognitive behavioral techniques, Therapeutic touch ,Humor, music therapy and distraction are useful for pain and anxiety management.Conclusion: Proper pain assessement ,considering the pathophysiology of different phases of burn, pharmacological and nonpharmacological approaches are critical in burn care.