Pain Management in Burn Patients

AIM OF INVESTIGATION: To review the pathophysiologic aspects and types of pain associated with burn injuries before delving into the existing literature pertaining to the efficacy of various analgesic and anesthetic medication classes while simultaneously highlighting clinical pearls of specific medications Methods: Literature review of various databases and professional journals utilizing combinations of words similar to analgesic, burn, management, pain, pathophysiology, and types Results: Burn injuries often result in acute and chronic pain syndromes with physiologic, pharmacokinetic, and pharmacodynamic implications that may even contradict one another. One of these changes may be alterations in organ function, specifically renal and hepatic systems, which can have a significant impact on the safety and efficacy of specific pain medications. Furthermore, burn injuries present five types of pain that require their own unique management strategies: background, breakthrough, chronic, post-operative, and procedural. In this population, chronic pain is expected for at least a period of time that may even span years. Guidelines related to pain management in burn populations focus on pain assessments, opioids, non-opioids, regional anesthesia, and nonpharmacologic management options. While opioids are a major player in burn injuries, the evidence-based results are lacking as to indicate why. Furthermore, non-opioid options often present mixed results or carry concerns of their own. Conclusion: Evidence-based medicine practices related to effective pain management regimens in burn injuries remain underdeveloped. Like many instances of pain, multimodal regimens should be utilized to target all pain types and physiologic pathways associated with pain. Regimens must be constantly evaluated and tailored to best meet the needs of patients, especially during transitions of care. Ultimately, more data and studies are needed to improve the quality of life and wellbeing of patients after burn injuries.