Pain management after burn trauma

Introduction

Pain after burn injuries is one of the most severe forms of acute pain. Although wound and pain management have gradually improved over the last years, a sufficient pain management after severe burn trauma is still a global problem and a major challenge for the health care personnel.

An adequate analgesia helps reducing complications and contributes to a faster healing.

Pain management is a vital part in the field of plastic surgery, anesthesia, psychology and physiotherapy.

Significance of pain management

Severe pain causes a number of various problems in the acute phase after burn injury, during rehabilitation and in the following years.

Apart from that, the relationship between the patient and the health care personnel will be significantly disturbed and the patient’s compliance with the therapy will be drastically influenced.

Uncontrolled or inadequately treated pain are associated with:

Increased tonus of the sympathetic system: this results in declined hemodynamics with disturbed microcirculation and increased oxygen consumption

Marc G. Jeschke et al. (eds.), Handbook of Burns

Intensified catabolic metabolic status accompanied by weight loss, muscle loss, reduced immunologic resistance and increased risk of infection

Suppressed breathing and immobility resulting in limited physiotherapy and longer recovery periods.

Incidence of chronic pain: Persisting pain leads to sensitization in the peripheral and central nervous system an eventually results in a so called pain memory [1]. Up to 50% of the patients with burn injuries suffer from chronic pain [2].

Incidence of stress disorder: uncontrolled pain and anxiety are high risk factors for acute stress disorder (for a maximum period of 4 weeks) or posttraumatic stress disorder (for a period of more than 6 months). Clinical symptoms include sleep disorders, increased nervousness, permanent psychic tension and depression. These symptoms affect all therapy phases negatively. A comparison of retrospective studies on surviving children after burn trauma from the years 1993–1994, 1998 and 2001 showed increased administration of opioids and benzodiazepines in this patient group whereas incidence of acute stress disorders decreased significantly during the same period [3].

Economic problems caused by high costs.

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