Pharmacologic approaches to burn pain in the hospital treatment of burn injured patients

Abstract

Burn injuries cause one of the most intense and prolonged types of pain in clinical practice. Recent literature suggests that early vigorous analgesic intervention is crucial to prevent the adverse consequences of uncontrolled burn pain. Burn pain is difficult to control because of its unique characteristics, extreme individual variability, multiple components, increased opiate requirements and changing patterns over time, which often led to undermedication and chronicity. The purpose of this study was to retrospectively review the records of hospitally treated adult burn patients, regarding the use of pharmacotherapy in the treatments of their burn pain. The 193 patients with severe burns, who were hospitally treated during the year 2003 at the University Hospital of Traumatology, Zagreb, Croatia, were selected as the sample for this study. 121 patients were males, and 72 were females, aged between 14 and 96 (mean age was 50, 06). The hospital stay ranged from 1 to 180 days. The extent of their injures ranged from small (63, 2%), large (29%) and extensive (7, 77%). The mean burned total body surface area was 26, 63%. On the base of medical records the authors analysed the pharmacotherapy of burn pain, as well as factors that influenced burn pain, such as depth of burn, nature of care procedures and patient characteristics. Pain medication were prescribed to all hospitalized patients. Continuous intravenous opiate infusions during the first several days of hospitalization were administered to patients with severe burns. Following that period, background pain were mostly treated with tramadol slow release tablets twice daily, and then followed by other oral analgesics. The daily doses of tramadol were 200-400 mg. More severe procedural pain was treated with intravenous application of tramadol (100 mg) or morfine (10 mg). Psychotropic agents as adjuvant pharmacotherapy for pain control as well as for comorbid psychiatric disorders have been prescribed to all patients. High quality burn pain management is very important for patient outcome. Burn pain vary unpredictably throughout hospitalization, so pharmacotherapy should be individually tailored and continuously evaluated to avoid problems of under- or over-medication. Further research on combination analgesics regimens, as well as on adjuvant pharmacotherapy for burn pain are required.