Burn Pain

Burn Pain
According to the American Burn Association, an estimated 450,000 burn injuries receive
medical treatment each year.1 A burn injury is one of the most painful injuries a person can
endure, and the subsequent wound debridement required to heal a burn injury is often more
painful than the initial injury.2
Burn pain is difficult to control because of its unique characteristics, its changing patterns, and
its various components. In addition, there is pain involved in the treatment of burns as the
wounds must be cleansed and the dressings
changed. Studies have found that the
management of burn pain can be inadequate, and
have recommended more aggressive treatment
for pain resulting from burns.3 Burn pain varies
greatly from patient to patient, shows substantial
fluctuation over time, and can be unpredictable
because of the complex interaction of physiologic,
psychosocial, and premorbid behavior issues.4
The average length of inpatient hospitalization for patients with burn injuries has declined
during the last 10 years from 11 to 9 days. This represents, on average, just more than one day
of hospitalization per 1% burn. As a result, patients with burn injuries are being discharged
with multiple, long-term, physical, and psychological challenges, such as ongoing pain,
intensive physical therapy, contractures, amputations, and psychological distress.4
Facts

Pain resulting from burn injuries can be challenging to treat because burns differ in
their types and severity. There are three types of burns:3
- first-degree burns are considered mild compared to other burns. They result in
pain and reddening of the epidermis (outer layer of the skin)
- second-degree burns affect the epidermis and the dermis (lower layer of skin).
They cause pain, redness, swelling, and blistering
- third-degree burns go through the dermis and affect deeper tissues. They result
in white or blackened, charred skin that might be numb
Burn Pain is generally classified into five clinical settings:4
1. Background: pain that is present while the patient is at rest, results from the
thermal tissue injury itself, and is typically of low-moderate intensity and long
duration (until the burn wound is healed).
2. Procedural: a brief but intense pain generated by wound care (e.g., debridement,
dressing change) or rehabilitation activities (physical and occupational therapies).
3. Breakthrough: an unexpected spiking of pain levels that occurs when analgesic
efforts are exceeded, either at rest or during procedures.
4. Postoperative: a predictable and temporary (2-5 days) increase in pain complaints
following burn excision and grafting, in large part because of the creation of new
wounds in the processes of skin graft harvesting and autografting.
5. Chronic: pain that lasts longer than six months or remains after all burn wounds
and skin graft donor sites have healed, and is thus a challenge primarily in the
outpatient setting.

The International Association for the Study of Pain (IASP) states that burn pain
management is deficient in elderly patients and in the vast population (about 95% of all
burn injuries) treated on an outpatient basis.5

IASP cites challenges surrounding the treatment of burn pain based on lack of research,
the unique nature and characteristics of burns, and complexities surrounding secondary
pain from wound care.5

An international wound care survey on pain and trauma at wound dressing changes
found that dressing removal was considered by practitioners to be the time of greatest
perceived pain.6

Not only is acute burn injury pain a source of immense suffering, but it has been linked
to debilitating chronic pain and stress-related disorders.7

Burn patients experience severe procedural pain and mild-to-moderate background
pain; one study also found that burn patients experience anxiety, fatigue, helplessness,
anorexia and acute stress disorder associated with background pain. 8

One study of 50 patients who had been admitted to the ICU with severe (third-degree)
burns found that after one year, the level of health of all survivors was worse than before
the injury. Problems reported include:9
- difficulty with mobility (moderate 68.5%; extreme 0%)
- self-care (moderate 21%; extreme 36.9%)
- usual activities (moderate 68.5%; extreme 21%)
- pain/discomfort (moderate 68.5%; extreme 10.5%)
- anxiety/depression (moderate 36.9%; extreme 42.1%).
2
Additional Resources
Alisa Ann Ruch Burn
Foundation
2501 West Burbank Boulevard
Suite 201
Burbank, CA 91505
Phone: (800) 242-BURN
Phone: (818) 848-0223
Fax: (818) 848-0296
E-mail: info@aarbf.org
Twitter: @AARBF
www.aarbf.org
American Burn
Association
311 South Wacker Drive
Suite 4150
Chicago, IL 60606
Phone: (312) 642-9260
Fax: (312) 642-9130
E-mail: info@ameriburn.org
Twitter: @Ameriburn
www.ameriburn.org
Burn Advocates Network
150 Broadway
Suite 900
New York, NY 10038
Phone: (877) BURN-411
E-mail:
sam@burnadvocates.org
Twitter: @BurnAdvocates
www.burnadvocates.org
The Phoenix Society for
Burn Survivors, Inc.
1835 R W Berends Drive SW
Grand Rapids, MI 49519-4955
Phone: (800)-888-2876
Phone: (616) 458-2773
Fax: (616) 458-2831
E-mail: info@phoenixsociety.org
Twitter: @PSburnsurvivors
www.phoenix-society.org
World Burn Foundation /
Burn Survivors Online
E-mail: Via website
www.burnfoundation.com
Resources verified March 2013.
References
1. American Burn Association. Burn Incidence and Treatment in the US: 2012 Fact Sheet.
http://ameriburn.org/resources_factsheet.php. Accessed March 12, 2013.
2. Patterson D, Ptacek J. “Baseline pain as a moderator of hypnotic analgesia for burn injury treatment.” J
Consult and Clin Psych. 1997 Feb;65(1):60-67.
3. Health Extra-Burn Pain. Cleveland Clinic Foundation. http://www.clevelandclinic.org/health/healthinfo/docs/3600/3660.asp?index=12063&src=newsp. Accessed March 12, 2013.
4. Wiechman SA. “Psychosocial recovery, pain, and itch after burn injuries.” Phys Med Rehabil Clin N Am.
2011 May;22(2):327-45.
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5. International Association for the Study of Pain. “Burn Pain: A Unique Challenge.” PAIN: Clinical Updates.
2001 Mar;9(1).
6. Moffatt CJ, Franks PJ, Hollinworth H. “Understanding wound pain and trauma: an international
perspective.” Eur Wound Mang Assn Position Document: Pain at Wound Dressing Changes. 2002.
7. Summer G, Puntillo K, Miaskowski C. “Burn injury pain: The continuing challenge” J of Pain. 2007
Jul;8(7):533-548.
8. Esfahlan AJ, Lotfi M, Zamanzadeh V, Babapuor J. “Burn pain and patients’ responses.” Burns. 2010
Nov;36(7):1129-1133.
9. Pavoni V, Gianesello L, Paparella L, Buoninsegni LT, Barboni E. “Outcome predictors and quality of life of
severe burn patients admitted to intensive care unit.” Scand J Trauma Resusc Emerg Med. 2010 Apr;
18:24.
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