Pain management in the adult patient with burn trauma

Abstract

Burns are a very frequent form of trauma, with a significantly high prevalence in underdeveloped countries compared to developed countries, associated with significant mortality. Among the main pathophysiological processes are protein denaturation and local necrosis. Burns can be classified according to etiology in thermal, electrical and chemical burns, and according to severity in first, second, third, fourth and fifth degree. Multiple elements participate in the pain mechanism of the burned patient, including type C and A delta nerve fibers, substance P, spinothalamic and spinoreticular tracts, the thalamus, the limbic system, cortical structures, among others. These patients usually experience four types of pain: background, breakthrough, procedural, and postoperative pain. Due to the complex mechanisms involved in burns, their treatment requires a multimodal approach involving surgical, pharmacological and non-pharmacological treatments, always individualizing each case according to the severity and characteristics of the burn, as well as the characteristics and comorbidities of the patient. Surgical treatment includes resection of eschars, closure of bloody wounds, and use of VAC. While within pharmacological treatment, intravenous potent opioids at high doses are the first choice. In addition, other options are available such as paracetamol, NSAIDs, NMDA receptor inhibitors, neuromodulators, among others. Finally, within the non-pharmacological treatment, psychological and psychiatric interventions such as cognitive-behavioral therapy stand out, as well as aromatherapy and massages. However, it is an area still under development. This bibliographical review aims to address the pathophysiology and mechanisms involved in the pain of burn patients, as well as to explore the evaluation of updated pharmacological, non-pharmacological and surgical therapies.