The management of pain in the burns unit

The adverse sequalae of inadequate pain control in the burn population have been long recognised, yet control of pain remains inadequate globally. The dynamic evolution of burn pain both centrally and peripherally, and the many factors which influence pain perception illustrate the need for a therapeutic plan which is similarly dynamic and flexible enough to cope with the facets of background, breakthrough, procedural and post-operative pain. Regular, ongoing and documented pain assessment is key in directing this process. The family of opioid analgesics provide the backbone of analgesia to burn patients. Together, they provide an excellent range of potencies, duration of actions and routes of administration. However, they must be used judiciously as side-effects may be clinically relevant and furthermore, recent data has implicated them as being capable of inducing pain. NMDA receptor antagonist such as ketamine and gabapentin are increasingly recognised as useful adjuncts, capable of marked opiate sparing effects in this population. The simple analgesic paracetamol (acetaminophen) has both anti-pyretic and opioid-sparing properties and justly deserves its place in the pharmacological treatment of every burn patient. Non-pharmacological methods of pain control can play an important role in suitable patients but resources vary widely between units. With this review article, we have set out to give practical guidance to all healthcare professionals with examples from our practice. We have found the addition of pain specialists as an integral part of the burns multi-disciplinary team, and an environment where pain is given a high clinical priority to be invaluable in our approach to pain control.