Naltrexone for the management of post-burn pruritus: A preliminary report

Severe pruritus after burn continues to be a clinical challenge that is inadequately addressed by traditional therapies. The success of naltrexone, an opioid antagonist, in treating pruritus in other patient populations, supported the concept that it may also be effective in burn survivors. Thus, burn patients who were dissatisfied with itch relief obtained after a course of traditional therapy were offered naltrexone. Of the 15 subjects included in this case series, 2 discontinued treatment because of side-effects. Of the remaining 13, 72% reported that they were satisfied with the itch relief provided by naltrexone, 69% were able to decrease or stop taking other medications to reduce itch, 85% would recommend it to other burn patients, and 62% divulged that it improved their quality of life. A sub-group (n=8) completed the French-Canadian version of the Questionnaire for Pruritus Assessment before and after a 2-week course of naltrexone treatment. Comparisons of individual responses before and after naltrexone treatment revealed that the affective impact of itch appeared to be less burdensome. The majority reported either a reduction or no change in the frequency of itch experienced. All reported either a decrease or no change in the duration of itch experienced after naltrexone treatment. All items that previously increased itch were less likely to affect itch or there was no change, except with fatigue, physical effort, sweating and eating. There was a statistically significant reduction in their visual analogue scale intensity ratings of itch "at its worst". Thus, naltrexone positively impacted the itch experienced by burn patients in association with a high percentage of patient-satisfaction. Further controlled trials are recommended.