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Management of burn wound pain and itching

Shelley Wiechman, PhD
Sam R Sharar, MD
Section Editor
Marc G Jeschke, MD, PhD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Burns can be extremely painful. Pain management, which includes pharmacologic and nonpharmacologic approaches, is a central component of the complex issues involved in treating patients with burns. Management of anxiety is also important given that high levels of anxiety can increase the perception of pain. Poor pain and anxiety management can also contribute to delayed wound healing [1]. Despite advances in burn care, inadequate burn pain management still exists during both the acute and rehabilitation phases of care [2]. Burn pain is among the most common causes of distress during the first year after discharge [3,4]. Unfortunately, burn pain management is frequently based upon tradition, personal bias, and/or institutional preference rather than evidence-based protocols, which report that such protocols reduce both pain and anxiety [5].

An overview of pharmacologic and nonpharmacologic options for the management of burn pain is reviewed here. Emergency care and local management of burns and pain are discussed elsewhere. (See "Emergency care of moderate and severe thermal burns in adults" and "Emergency care of moderate and severe thermal burns in children" and "Local treatment of burns: Topical antimicrobial agents and dressings" and "Paradigm-based treatment approaches for burn pain control".)


All burns are painful initially [6]. Burn pain varies greatly from patient to patient, shows substantial fluctuation over the hospitalization course, and can be unpredictable due to the complex interaction of anatomic, physiologic, psychosocial, and premorbid behavior issues. Burn patients typically report pain as being severe or excruciating, despite receiving opioid analgesics.

Burn pain also varies depending upon depth of burn (figure 1) (see "Classification of burn injury"):

Superficial partial-thickness burns result in hyperalgesia and mild-to-moderate pain. They are the most painful burns immediately following the injury. These burns damage only the outer layers of the skin.

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Literature review current through: Sep 2017. | This topic last updated: Sep 14, 2017.
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