Analgesic use and pain burden in adults with major burns: A retrospective analysis

Pain control in severe burns remains challenging due to physiological factors affecting drug metabolism and efficacy. This study characterizes the most frequent combinations of pain medication, dosages of opioids and non-opioids over time, and their correlation with pain management in adults.

A single-center retrospective analysis of patients ≥ 18 years of age admitted to University of North Carolina Jaycee Burn Center with ≥ 20% total body surface area (TBSA) burn injury between 2020 and 2024 was performed. Records were abstracted for demographics, prescription pain medication management, and numerical rating scale (NRS) pain scores. Generalized linear and mixed models assessed average daily pain scores and morphine milligram equivalents (MME), adjusted for age, TBSA burn, and inhalation injury.

140 patients were included (age: 32 ± 7 years; 72% male; TBSA burn 37 ± 19% [range: 20-98%]; length of stay: 42 ± 54 days; 19% inhalation injury). 88% survived and most injuries were flame-related (76%). Opioid-only regimens accounted for 7% of prescribing medications, non-opioid-only 15%, and multimodal regimens 78%. Acetaminophen and hydromorphone were most frequently administered (17%), followed by acetaminophen, hydromorphone, and oxycodone (14%) and acetaminophen, fentanyl, and oxycodone (13%). Patients receiving multimodal or opioid-only regimens demonstrated lower and more stable pain trajectories than those receiving non-opioids alone. Hydromorphone use increased with burn severity and was highest in patients with > 80% TBSA. Although opioid requirements declined over time, patients with burns > 40% TBSA had significantly higher MME at day 25 compared with moderate burns (451 ± 980 vs 237 ± 388; p = 0.023).

Multimodal analgesia predominated and was associated with improved pain stability. Persistent opioid requirements in larger burns highlight the impact of burn-related metabolic alterations and support development of individualized analgesic strategies to optimize dosing and reduce prolonged opioid exposure.