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Pain during burn dressing change in children: relationship to burn area, depth and analgesic regimens
Nancy E Atchison1, Patricia F Osgood, Daniel B Carr
1Departments of Anesthesia and Medicine, Shriners Burns Institute. Massachusetts General Hospital, Boston, MAU.S.A. Harvard Medical School, Boston, MAU.S.A.
Insights
Children with severe burns experience significant pain during dressing changes. Pain intensity correlates with burn size, challenging the myth that deep burns are painless and indicating a need for revised pain management strategies.
Area of Science:
- Pediatric Burn Care
- Pain Management
- Wound Healing
Background:
- Acute burns in children cause severe pain, particularly during wound care procedures like burn dressing changes (BDC).
- Current pain management approaches may be inadequate for pediatric burn patients, especially those with extensive injuries.
Purpose of the Study:
- To quantify pain levels experienced by children undergoing BDC.
- To investigate the relationship between burn severity, size, and pain.
- To evaluate the effectiveness of current analgesic practices in pediatric burn patients.
Main Methods:
- Pain scores were collected before, during, and after BDC in acutely burned children.
- Correlation analysis was performed between pain scores and body surface area (BSA) affected by burns, including the percentage of third-degree burns.
- Analgesic administration and patient characteristics were recorded.
Main Results:
- Pain scores were significantly higher during BDC, indicating severe procedural pain.
- A positive correlation was observed between pain scores and BSA burned.
- Contrary to common belief, larger areas of third-degree burns were associated with greater pain.
- Patients with BSA > 70% reported severe pain during BDC, irrespective of opioid type, dose, or route.
Conclusions:
- Education is needed to dispel the misconception that third-degree burns are painless.
- Analgesic prescribing patterns for burned children require revision.
- Further research is necessary to understand the mechanisms of opioid resistance in severe burn pain.
Abstract:
To determine the level of pain that acutely burned children experience, we obtained pain scores before, during and after burn dressing change (BDC). Pain scores were higher during the BDC, consistent with severe pain during this procedure. A positive correlation between pain scores and the body surface area (BSA) burned suggests that pain increases with the size of the burn. Contrary to widely held beliefs, comparison of mean pain scores and the percent of 3rd degree burn revealed that the larger the area of full-thickness injury, the greater the pain. Regardless of wide variations in patient characteristics, fixed doses of oral narcotics were usually prescribed for pain. Patients with BSA greater than 70% experienced severe pain during BDC despite the type, dose or route of opioids. These findings suggest the need for (a) education to correct the myth that 'third-degree burns don't hurt'; (b) revision of analgesic prescribing patterns in the burned child; and (c) research to determine the mechanisms (e.g., tolerance or deafferentation) underlying the opioid-resistant nature of pain after large burns.