Clinical practice guidelines on the management of acute pain in the adult burn patient were released in September 2020 by the American Burn Association.
Elements of the pain assessment are as follows:
Perform several times daily.
Follow a protocol to ensure consistency in language.
If able, use pain assessment tools: patient-reported scales, Burn Specific Pain Anxiety Scale (BSPAS), Critical Care Pain Observation Tool (CPOT).
For opioid pain medications, the choice should be based on physiology, pharmacology, and physician experience. It should be individualized to the patient, with frequent adjustments to account for individual patient responses, the narrow therapeutic effects, and adverse effects. Use as few opiate equivalents as necessary for successful pain control. They should be used together with nonopioid and nonpharmacological measures. Educate patients about opioids and other pain medications and their roles in recovery.
The roles of nonopioid pain medications are as follows:
Acetaminophen: Use on all burn patients; monitor maximum daily dose.
NSAIDs: Consider use, owing to safety profile and efficacy; factors to consider include patient clinical picture (comorbidities) and surgeon preference.
Neuropathic pain agents (eg, gabapentin, pregabalin): Consider as adjuncts to opioids in those with neuropathic pain or whose pain is refractory to standard therapy.
Ketamine: Consider use for procedural sedation or in low doses as an adjunct to opioids in those who in whom reduced opioid consumption would be beneficial, in particular postoperatively.
Dexmedetomidine and clonidine: Recommended as pain management adjuncts; particular scenarios include patient signs of withdrawal and/or prominent anxiety; dexmedetomidine is a first-line choice for intubated burn patients.
Intravenous lidocaine: Not recommended as a first-line agent; however, it can be considered as a second- or third-line adjuvant.
Cannabinoids: Not recommended, owing to lack of evidence along with potential legal and political obstacles.
The use of regional anesthesia for burn pain management can potentially achieve improved pain relief, improved patient satisfaction, and a reduction in opioid use, without serious risks or complications.
Nonpharmacologic pain control techniques should be offered to every patient. The modalities for which the strongest evidence exists are hypnosis, cognitive-behavioral therapy, and virtual reality.
For more information, see Thermal Burns and Emergent Management of Thermal Burns.
For more Clinical Practice Guidelines, go to Guidelines.
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Cite this: Clinical Practice Guidelines for the Management of Acute Pain in the Adult Burn Patient (ABA, 2020) - Medscape - Oct 02, 2020.