Burn Pain: A Systematic and Critical Review of Epidemiology, Pathophysiology, and Treatment

Burns pain management: The role of nurse-patient communication

BACKGROUND

Nursing is an embodiment of knowledge, clinical work, and interpersonal communication. Effective nursing care has a distinct influence on the overall satisfaction and experience of the patient. Communication is said to be indispensable in the delivery of quality healthcare. Effective communication between nurses and patients has proven to yield better results with pain control and improved psychological status of patients.

OBJECTIVES

The aim of the study is to explore nurses' perceptions on the role of communication in the management of burns pain.

METHODS

A qualitative design with purposive sampling was carried out to recruit 11 registered nurses from a Reconstructive Plastic Surgery and Burns Center in Ghana. To identify the participants' perception on the role of nurse-patient communication in the management of burns pain, a face to face semi-structured interviews were conducted using an interview guide to collect data.

RESULTS

Thematic analysis was done with various themes emerging. Helping patients manage pain, early detection of patient's distress, improved patient participation in their care were some of the positive effects of nurse-patient communication whiles reduced level of cooperation during caregiving, and endurance of pain by the patient were the results of poor nurse-patient communication. Language and time factor were the barriers that were identified to hinder effective communication between nurses and patients.

CONCLUSIONS

Due to the subjective nature of pain, the current study highlights the need for increased communication for an effective assessment and management of pain among patients with burns. It is, therefore, imperative that nurses be well trained in communication with an emphasis on patient-centered communication.

Risk factors associated with higher pain levels among pediatric burn patients: a retrospective cohort study

INTRODUCTION

There is an absence of evidence regarding predictors of moderate to severe pain in children undergoing acute burn treatment. This investigation aimed to determine if relationships existed between patient and clinical characteristics, and pain at first dressing change for children with acute burn injuries.

METHODS

A retrospective cohort investigation was conducted using clinical data from pediatric burn patients treated at the Queensland Children's Hospital, Brisbane, Australia. Data extracted included patient and burn characteristics, first aid, and follow-up care. Observational pain scores were categorized into three groups (mild, moderate, and severe pain), and bivariate and multivariable relationships were examined using proportional odds ordinal logistic regression. Data from 2013 pediatric burns patients were extracted from the database.

RESULTS

Factors associated with increased odds of procedural pain included: hand burns (OR 1.7, 95% CI 1.3 to 2.1, p<0.001), foot burns (OR 1.5, 95% CI 1.1 to 2.1, p<0.01), baseline pain (OR 5.5, 95% CI 2.8 to 10.8, p<0.001), deep dermal partial-thickness injuries (OR 7.9, 95% CI 4.0 to 15.6, p<0.001), increased burn size (OR 1.1, 95% CI 1.0 to 1.2, p<0.01), four or more anatomical regions burned (OR 3.6, 95% CI 1.5 to 8.6, p<0.01), initial treatment at a non-burns center (OR 1.8, 95% CI 1.4 to 2.3, p<0.001), and time to hospital presentation (OR 0.9, 95% CI 0.8 to 0.9, p<0.001). These burn characteristics are associated with increased odds of moderate to severe procedural pain during a child's first dressings change.

DISCUSSION

It is recommended that patients presenting with one or more of the aforementioned factors are identified before their first dressing change, so additional pain control methods can be implemented.

Irisin Gene Delivery Ameliorates Burn-Induced Sensory and Motor Neuropathy

Burn-related neuropathy is common and often involves pain, paresthesia, or muscle weakness. Irisin, an exercise-induced myokine after cleavage from its membrane precursor fibronectin type III domain-containing 5 (FNDC5), exhibits neuroprotective and anti-inflammatory activities. A rat model of third-degree burn on the right hind paw was used to investigate the therapeutic role of irisin/FNDC5. Rats received burn injury and were treated with intrathecal recombinant adenovirus containing the irisin sequence (Ad-irisin) at 3 weeks postburn. One week later, mechanical allodynia was examined. The expression of irisin in cerebrospinal fluid (CSF) was detected. Ipsilateral gastrocnemius muscle and lumbar spinal cord were also obtained for further investigation. Furthermore, the anti-apoptotic effect of recombinant irisin in SH-SY5Y cells was evaluated through tumor necrosis factor alpha (TNFα) stimulus to mimic burn injury. We noted intrathecal Ad-irisin attenuated pain sensitization and gastrocnemius muscle atrophy by modulating the level of irisin in CSF, and the expression of neuronal FNDC5/irisin and TNFα in the spinal cord. Ad-irisin also ameliorated neuronal apoptosis in both dorsal and ventral horns. Furthermore, recombinant irisin attenuated TNFα-induced SH-SY5Y cell apoptosis. In summary, irisin attenuated allodynia and muscle wasting by ameliorating neuroinflammation-induced neuronal apoptosis.

Pain assessment following burn injury in Australia and New Zealand: Variation in practice and its association on in-hospital outcomes

BACKGROUND

Pain is common following burn injury. Pain assessments are required to ensure appropriate pain management is provided. This study aimed to describe the prevalence and potential variation in practice of validated and documented pain assessment following burn injury in Australian and New Zealand burn units, identify clinical characteristics of patients who receive a pain assessment, and explore the associations between receiving a pain assessment and in-hospital outcomes.

METHODS

Burns Registry of Australia and New Zealand (BRANZ) admissions data were extracted. Responses to the pain assessment field were presented by contributing burns unit using frequencies and percentages. Demographic, injury severity and event, and in-hospital outcomes data were assessed.

RESULTS

There were 3009 admissions over the study period; 2481 of these received an assessment. The rate of pain assessment varied considerably between units. Women and adult patients more commonly received a pain assessment. Receiving a pain assessment was associated with a 53% adjusted increase in LOS.

CONCLUSIONS

There are differences in the profile of patients who receive a pain assessment after burn injury. The findings of this study will be reported back to designated burns units to improve pain assessment rates and patient care.

Effect of lycopene on pain facilitation and the SIRT1/mTOR pathway in the dorsal horn of burn injury rats

To explore the effect of intrathecal injection of lycopene on pain facilitation, glial activation, and the SIRT1/mTOR pathway in the dorsal horn of rats with burn injury pain (BIP). Here we found that the mechanical pain threshold increased in the lycopene group compared with that of the control group, (P < 0.05). Compared with expression in the sham group, mTOR, pS6, p4EBP, GFAP, and Iba-1 decreased and SIRT1 increased in the lycopene group (P < 0.01). Glial activation in the spinal dorsal horn of BIP rats was alleviated by lycopene (P < 0.01). The SIRT1 and mTOR were mainly distributed in neurons in the spinal dorsal horn in the BIP model. Intrathecal injection of 3-MA (a mTOR agonist) or EX-527 (an inhibitor of Sirt1) partially antagonized lycopene-induced analgesia. Intrathecal injection of rapamycin (an mTOR inhibitor) or SRT1720 (an agonist of Sirt1) induced analgesia in BIP rats. 3-MA abrogated the SRT1720-induced analgesic effects. The present data indicated that the SIRT1/mTOR pathway changed in the spinal dorsal horn of BIP rats; Lycopene alleviated the pain sensitization of BIP rats by regulating the SIRT1/mTOR pathway and glial activation in the spinal dorsal horn.

Challenges in anaesthesia and pain management for burn injuries

Burn-injured patients provide unique challenges to those providing anaesthesia and pain management. This review aims to update both the regular burn anaesthetist and the anaesthetist only occasionally involved with burn patients in emergency settings. It addresses some aspects of care that are perhaps contentious in terms of airway management, fluid resuscitation, transfusion practices and pharmacology. Recognition of pain management failures and the lack of mechanism-specific analgesics are discussed along with the opioid crisis as it relates to burns and nonpharmacological methods in the management of distressed patients.

Meeting the Challenge of Analgesia in a Pregnant Woman With Burn Injury Using Subanesthetic Ketamine: A Case Report and Literature Review

Pain management guidelines for burn injury in pregnant women are scarce. Maternal and fetal morbidity and mortality in pregnant burn patients have been shown to be higher than that of the general population, especially in severe burns. Early intervention and interdisciplinary treatment are critical to optimize maternal and fetal outcomes. Proper pain management is central to wound treatment, as poor control of pain can contribute to delayed healing, re-epithelialization, as well as persistent neuropathic pain. We present this case of a 34-year-old female patient who suffered an 18% total body surface area burn during the third trimester of pregnancy to demonstrate that ketamine can be considered as an adjunct for procedural and background analgesia during the third trimester, as part of a multimodal strategy in a short-term, monitored setting after a thorough and complete analysis of risks and benefits and careful patient selection.

The Acute Effect of Skin Preheating on Capsaicin-Induced Central Sensitization in Humans

INTRODUCTION

Topical capsaicin is commonly employed to experimentally induce central sensitization (CS) in humans. While previous studies have investigated the effect of skin preheating on the sensitizing effect of capsaicin, no studies have compared the synergistic effect of skin preheating on the magnitude of sensitization via topical capsaicin within the first 30 minutes of application. We tested the hypothesis that skin preheating potentiates the sensitizing effect of topical capsaicin by evoking a larger region of secondary hyperalgesia vs. topical capsaicin alone.

METHODS

Twenty young, healthy subjects each received topical capsaicin (Zostrix HP 0.075%) only (CAP), topical capsaicin with preheating (CAP + HEAT), and topical nonsensitizing placebo cream (CON) in a crossover design. Capsaicin and placebo creams were applied to a 50 cm² area of the dorsal forearm. The CAP + HEAT session also included a 10-minute preheating session. Regions of secondary hyperalgesia were assessed using mechanical brush allodynia testing, and skin temperature was assessed via infrared thermography. Outcomes were normalized to baseline and compared at 10, 20, and 30 minutes after cream application.

RESULTS

The CAP + HEAT session led to a significantly larger area of secondary hyperalgesia compared to the CAP session as measured by brush allodynia (CON: 0 ± 0 cm; CAP: 2.08 ± 0.45 cm; CAP + HEAT: 3.70 ± 0.46 cm; P < 0.05) and skin temperature (CON: -2.92% ± 0.03%; CAP: -0.63% ± 0.09%; CAP + HEAT: 2.50% ± 0.11%; ( of baseline) P < 0.05).

CONCLUSION

Preheating amplifies the sensitizing effect of topical capsaicin within 30 minutes of application. The heat-capsaicin technique may be employed to assess differing magnitudes of CS induction and enables future studies investigating the development and progression of CS in humans.

Efficacy and safety of basic fibroblast growth factor in the treatment of burns: Protocol for a systematic review and meta-analysis of randomized controlled trials

BACKGROUND

To systematically evaluate the efficacy and safety of basic fibroblast growth factor (bFGF) in the treatment of burns and to provide evidence-based medical information for clinicians to choose the appropriate treatment measures for burns.

METHODS

Seven databases, including PubMed, the Cochrane Library, Embase, the Chinese Biomedical Literature Database, the Wanfang Database, the China National Knowledge Infrastructure Internet, and the Chongqing Chongqing Weipu Chinese Science and Technology Journal Full-text Database (VIP), were searched by computer. Randomized controlled trials on bFGF in the treatment of burns were collected, and the search was conducted by using a combination of subject terms (MeSH) and free words. The search time limit was from the establishment of each database until January 2019. Two researchers independently screened the literature and extracted the data. According to the evaluation criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions version 5.3.0, they conducted a rigorous bias risk assessment for the included studies, and Stata 12.0 software was used for meta-analysis.

RESULTS

System evaluation and meta-analysis were carried out strictly in accordance with the requirements of the Cochrane Handbook for Systematic Reviews of Interventions version 5.3.0 on meta-analysis and provided a high-quality evaluation of the efficacy and safety of bFGF in the treatment of burns.

CONCLUSION

This study provided conclusions from evidence-based medicine and a scientific basis for the efficacy and safety of bFGF in the clinical treatment of burns.

ETHICS AND DISSEMINATION

This study was not a clinical trial and therefore did not require ethical approval. The results of this study will be published in an SCI academic journal related to this study in the form of a public publication.

PROSPERO REGISTRATION NUMBER

CRD42019124778.

Welfare Effects of the Use of a Combination of Local Anesthesia and NSAID for Disbudding Analgesia in Dairy Calves-Reviewed Across Different Welfare Concerns

Across the international dairy industry, the vast majority of dairy herds have dehorned cows. Farmers choose to dehorn calves for different reasons such as easier handling of non-horned cattle and reduced risk of injuries in animals and staff. This review focuses on disbudding by use of hot-iron cautery as is practiced by dairy farmers in calves <3 months of age. We examine welfare effects of the use of NSAIDs in combination with a local anesthetic including indicators relevant for the three major welfare concerns-affective states, basic health, and functioning as well as the possibility to behave naturally. Across indicators of animal welfare, the majority of available evidence suggest that the use of NSAIDs in combination with a local anesthetic is advantageous in terms of animal welfare, and no studies suggest that NSAIDs are a disadvantage to animal welfare. However, irrespective of the welfare concern, use of NSAIDs combined with a local anesthetic does not fully eliminate the welfare challenges from disbudding. Further research is needed in order to fully understand the effects of this medication protocol on calf welfare, including knowledge about the duration of healing and the presence of long-term pain. At present, this lack of knowledge challenges the precise formulation of adequate pain management-in terms of medication protocol, duration, dosage, and type of administration.