A Descriptive Review of Neuropathic-Like Pain Following Burn Injury

Abstract

Neuropathic-like pain consisting of a pins and needles, burning or lancinating sensation is a common complaint of burn patients following healing of their open wounds. In our experience, this pain is often a significant complaint on long-term follow-up. However, there exists no published study outlining the clinical course of this common symptom following burns. A description of the natural history of this symptom would be useful to burn clinicians and their patients. A retrospective chart review over a twenty-four month period of patients treated at an outpatient burn center was performed. The medical records of patients with a complaint of pins and needles, burning, stabbing, or electric shock-like pain were included for analysis. Medical and demographic data was collected. We identified 72 patients for inclusion in the study. The age was 44 ± 2 (mean ± SEM) and total body surface area burned was 18±3%. The first complaint of neuropathic-like symptoms was at 4.3±0.5 months after injury. Documentation of improvement in the symptoms occurred at 7.0±0.8 months. Symptoms persisted for 13.1±2.2 months after the injury. Patients were followed for 14.5±2.2 months and 40% of patients still reported pain at their last clinic visit. Documented initial pain severity score was 7 ± 1 out of ten. Typical exacerbating factors included temperature change, dependent position, light touch and activity. Common alleviating factors included cool water immersion, massage, compression garment use and elevation. Treatment regiments often included gabapentin (38%) and steroid injections (21%). Hypertrophic scarring (43%), pruritis (40%) and psychiatric diagnoses (36%) were common associated problems.