Pain management in the burned patient

The pain experienced by a burned patient is influenced by many factors, from initial suffering, through various painful treatments, to chronic and intractable discomforts in scar tissue. Burn pain varies with burn size, but the relationship is not linear and assessments by staff are often inaccurate. Contributing psychological factors need to be recognized and addressed. Burn pain is a combination of nociceptor response to heat and other stimuli, aggravated by both primary and secondary hyperalgesia. Therapy must be tailored to the patient's needs after careful assessment. The pain experience can be divided, for therapeutic convenience, into: acute pain on admission, day-to-day background discomfort (including the analgesic needs of the ventilated patient), pain due to surgical intervention (including donor site pain), and pain associated with dressings changes and other procedures. All need carefully planned pain relief strategies based on regular assessment and tailored therapy, since no two patients are alike in their response; this must include relevant psychological and emotional support. Specific pain patterns associated with unusual burns or with nonburn causes must be recognized and managed appropriately. Psychological techniques may be of great value in some patients. Paediatric pain has been undertreated in the past, but, with a thorough knowledge of pain expression in children, and by involving parents, this is gradually improving. Late discomfort is common after burn injury and is compounded by intense itching, for which there are few remedies, none very effective.