Paradigm-based treatment approaches for burn pain control
- Shelley Wiechman, PhD
Shelley Wiechman, PhD
- Associate Professor, Department of Rehabilitation Medicine
- University of Washington
- Sam R Sharar, MD
Sam R Sharar, MD
- Professor, Department of Anesthesiology
- University of Washington
Pain management is a central component of the treatment of patients with burns. Despite advances in burn care, control of burn pain is often inadequate during the acute and chronic rehabilitation phases of burn care . Pain is among the most common causes of distress during the first year after recovery and, hence, should be aggressively managed [2,3]. Burn pain management is typically based upon clinical experience and physician and/or institutional preference, since available evidence is insufficient to clearly support one approach .
The approach to the management of patients with acute, background, procedural, and chronic pain secondary to burns will be discussed here. An overview of the pharmacologic and nonpharmacologic treatment options for managing burn pain is reviewed elsewhere. (See "Burn pain: Principles of pharmacologic and nonpharmacologic management".)
BURN PAIN PARADIGM
A burn pain paradigm guides the use of analgesics for management of the different phases and variability of burn pain . This paradigm is based upon five phases of burn pain occurrence and includes:
●Background pain – Pain that is present while the patient is at rest, results from the thermal tissue injury itself, and is typically of low-to-moderate intensity and long duration.
●Procedural pain – Brief but intense pain that is generated by wound debridement and dressing changes and/or rehabilitation activities (eg, physical therapy and occupational therapy).
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