Pain Management in Geriatric Burn Patients: A Scoping Review of Strategies and Key Issues

Jonathan Bayuo

doi:10.3390/ebj2040014

Abstract

The effect of poorly treated pain is well documented in the literature. To offer support for the development of geriatric-specific pain management protocols, this review sought to scope the literature to identify what has been accomplished in geriatric burn pain management and offer suggestions. Arksey and O’Malley’s scoping review methodology was employed with extensive database and grey literature searches. A narrative synthesis was employed to analyse the evidence. The PRISMA extension guidelines for scoping reviews were followed in reporting this review. Sixteen evidence types comprising eleven reviews, two retrospective studies, two book chapters, and one practice guideline were retained in the review. The two retrospective studies emerged from the United States. The review findings suggest that though a plethora of generic pain assessment tools exist, they are yet to be validated in the older adult burn population. Pain management strategies involved the use of pharmacological agents (mainly opioids), but no outcome regarding pain relief was reported. Key issues identified include cautious use of opioids, oversedation concerns, and varied complexities associated with pain management. Though the literature remains largely unexplored, the complexities associated with geriatric burn pain management suggest a need for a multidisciplinary approach. More prospective studies are also needed to evaluate both pharmacological and non-pharmacological interventions in the geriatric burn population.

Highlights

All the reviews and book chapters discussed burn management in the elderly broadly with few sections dedicated to pain management which may highlight the limited scope of work regarding geriatric burn pain management
There is a general lack of pain assessment tools specific to the geriatric burn population and the generic types available which are often employed have not been validated among this group
Though the literature remains largely unexplored, the complexities associated with geriatric burn pain management suggest a need for a multidisciplinary approach including pharmacists and specialists from geriatric medicine to offer comprehensive support whilst considering underlying comorbid and polypharmacy issues

Summary

Introduction

The older adult population is one of the fastest-growing populations and at the same time, remains highly susceptible to burn injuries [1,2]. The increased susceptibility of older adults to burn injuries is related to varied factors such as diminishing physical strength, altered protective mechanisms, poor eyesight, presence of several pre-morbid conditions, and diminished reaction time [3]. The process of aging is associated with several physiological alterations that result in decreased functional reserves and a diminished ability to adapt to the injury. The relatively atrophic skin of elderly persons makes the resulting burns deeper [4,5]. The severity of the hypermetabolic response to burn injury increases with age and may result in an exaggerated response to the injury among elderly persons [5]

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