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Paradigm-based treatment approaches for burn pain control

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


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 [1]. 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 [4].

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 "Management of burn wound pain and itching".)


A burn pain paradigm guides the use of analgesics for management of the different phases and variability of burn pain [5]. 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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Literature review current through: Nov 2017. | This topic last updated: Mar 27, 2017.
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