590 Nonpharmacologic Pain Management in Pediatric Burn Patients: A Systematic Review

Abstract

Abstract Introduction Pain is a universal feature of pediatric burns that is associated with long-term mental health consequences in this population. While pharmacologic therapy can alleviate pain, it does not always provide complete control and carries its own risks. Current literature suggests nonpharmacologic treatment may provide improved pain control as an effective adjunct in pediatric burn patients. The aim of this systematic review is to summarize the literature of nonpharmacologic pain management in pediatric burn patients. Methods A systematic review was conducted using PubMed, Ovid MEDLINE, Scopus, and Web of Science. Keywords included: analgesia, pain, children, pediatric, paediatric, child, young, adolescent, burn, and scald. Papers were included if they were randomized, controlled, had original data, collected pain scores as a function of nonpharmacologic treatment, and were conducted on pediatric burn patients. Reviews, case reports, and opinion papers were excluded. Data were extracted on pain scale, pain score during and after treatment, and significance of results. Pain reduction was calculated as the percent difference between experimental and control pain scores, and treatments with significant pain reduction were considered effective. Results Sixteen studies were included, with nonpharmacologic treatments categorized as interactive (n=12) or passive (n=4). Interactive treatments required patient activity throughout treatment and included virtual reality (n=6), distraction devices (n=3), child life therapy (n=1), directed play (n=1) and digital tablet games (n=1). Passive treatments included cartoons (n=1), hypnosis (n=1), massage therapy (n=1) and music (n=1). Mean age was 8.39 years and percent total body surface area (%TBSA) burned was 5.95%. Treatment was effective in 9 out of 16 studies. Compared to controls, nonpharmacologic treatments reduced mid procedure pain by 24.3% (n=12) and post-procedure pain by 33.6% (n=5). Of the studies reporting mid procedure pain, pain reduction was greater in interactive treatments (32.3% n=10) than in passive treatments (-15.6% n=2) (p=.016). Conclusions Nonpharmacologic therapy can be an effective adjunct in pediatric burn pain management. Significantly greater pain reduction in interactive treatments suggests distraction may lead to greater analgesia; however, the number of passive treatments for comparison was low. This study shows promise in the application of nonpharmacologic therapy, and further research will allow standardized algorithms to integrate nonpharmacologic therapy with medications.