Burn pain: the management of procedure-related pain

Burn-related pain is often severe and intermittently excruciating for months after the initial injury as the result of the multiple procedures these patients must undergo. Procedure-related pain is often undertreated, especially in children. Pain management should be integrated into the patient's overall care plan. Frequent pain assessment with valid patient self-report measures should be the basis for documenting pain treatment efficacy. Pharmacologic methods of pain management, including the use of opioids and nonopioid analgesics, are the mainstay of pain management. The patient with burns often has altered pharmacokinetics and pharmacodynamics to drugs, and these changes must be integrated into the use of these agents. In addition, individual patient response varies widely, necessitating a highly individualized pain management plan. Sedatives, such as benzodiazepines, are often very helpful adjuncts to opioids in anxious patients but should not be substituted for analgesics. Psychological techniques have proved to be very helpful adjuncts to analgesics but should also not be sued as a substitute for analgesics. General anesthesia should be considered, especially in children, when patients are to undergo extremely painful procedures. Patients need not experience severe pain after burn injury. Pain management, especially during very painful procedures, should be an integrated part of patients care and high-quality pain management to improve patient outcome.