Table 2.
Evidence-based literature review of current knowledge regarding treatment of burn-related pain
| Topic | Reference (numbers in italics are reference number from manuscript) | Data class |
|---|---|---|
| Pain Assessment |
Ashburn MA. Burn pain: the management of procedure-related pain. J Burn Care Rehabil 1995;16(3 Pt 2):365–71. 13 | Level 5, grade D |
| Browne AL et al. Persistent pain outcomes and patient satisfaction with pain management after burn injury. Clin J Pain 2001;27(2):136–45. | Level 4, grade C | |
| Carrougher GJ et al. Comparison of patient satisfaction and self-reports of pain in adult burn-injured patients. J Burn Care Rehab 2003;24(1):1–8. 2 | Level 2c, grade B | |
| Casser HR et al. Multidisciplinary assessment for multimodal pain therapy. Indications and range of performance. Schmerz 2013;27(4):363–70. | Level 5, grade D | |
| Choiniere M et al. The pain of burns: characteristics and correlates. J Trauma 1989;29:1531–9.3 | Level 4, grade C | |
| Connor-Ballard PA. Understanding and managing burn pain: part 1. Am J Nurs 2009;109(4):48–56; quiz 57. | Level 5, grade D | |
| Connor-Ballard PA. Understanding and managing burn pain: Part 2. Am J Nurs 2009;109(5):54–62; quiz 63. | Level 5, grade D | |
| de Castro RJ et al. Pain management in burn patients. Braz J Anesthesiol 2013;63(1):149–53.14 | Level 5, grade D | |
| de Jong AE et al. The visual analogue thermometer and the graphic numeric rating scale: a comparison of self-report instruments for pain measurement in adults with burns. Burns 2015;41(2):333–40.15 | Level 2b, grade B | |
| de Jong AE et al. Pain in young children with burns: extent, course and influencing factors. Burns 2014;40(1):38–47.16 | Level 2b, grade C | |
| de Jong A et al. Reliability, validity and clinical utility of three types of pain behavioral observation scales for young children with burns aged 0–5 years. Pain 2010;150(3):561–7. | Level 2b, grade C | |
| de Jong AE et al. Reliability and validity of the pain observation scale for young children and the visual analogue scale in children with burns. Burns 2005;31(2):198–204.17 | Level 4, grade C | |
| Echevarria-Guanilo ME et al. Reliability and validity of the Brazilian-Portuguese version of the Burns Specific Pain Anxiety Scale (BSPAS). Int J Nurs Stud 2011;48(1): 47–55. | Level 2c, Grade B | |
| Esfahlan AJ et al. Burn pain and patients’ responses. Burns 2010;36(7):1129–33. | Level 2b; grade C | |
| Gelinas C. Pain assessment in the critically ill adult: recent evidence and new trends. Intensive Crit Care Nurs 2016;34: 1–11.18 | Level 5, grade D | |
| Griggs C et al. Sedation and pain management in burn patients. Clin Plast Surg 2017;44(3):535–40. | Level 5, grade D | |
| Gamst-Jensen H et al. Acute pain management in burn patients: appraisal and thematic analysis of four clinical guidelines. Burns 2014;40(8):1463–9. | Level 5 grade D | |
| Gordon M et al. Use of pain assessment tools: is there a preference? J Burn Care Rehabil 1998;19(5):451–4.19 | Level 1b, grade B | |
| Jonsson CE et al. Background pain in burn patients: routine measurement and recording of pain intensity in a burn unit. Burns 1998;24(5):448–54.20 | Level 2b, grade B | |
| Kohler H et al. Pain management in children: assessment and documentation in burn units. Eur J Pediatr Surg 2001;11(1):40–3.21 | Level 2C grade C | |
| Mahar PD et al. Frequency and use of pain assessment tools implemented in randomized controlled trials in the adult burns population: a systematic review. Burns 2012;38(2):147–54.22 | Level 2a, grade B | |
| Martin-Herz SP et al. Pediatric pain control practices of North American Burn Centers. J Burn Care Rehab 2003;24(1):26–36. | Level 2c grade C | |
| McGhee LL et al. The relationship of early pain scores and posttraumatic stress disorder in burned soldiers. J Burn Care Res 2011;32(1):46–51. | Level 3b, grade C | |
| Myers R et al. Sedation and analgesia for dressing change: a survey of American Burn Association Burn Centers. J Burn Care Res 2017;38(1):e48–54. | Level 2c, grade C | |
| Payen JF et al. Assessing pain in critically ill sedated patients by using a behavioral pain scale. Crit Care Med 2001;29(12):2258–63.23 | Level 4, grade C | |
| Perez Boluda MT et al. The dynamic experience of pain in burn patients: a phenomenological study. Burns 2016;42(5):1097–04.24 | Level 4, grade C | |
| Perry S et al. Assessment of pain by burn patients. J Burn Care Rehabil 1981;2:322–7.4 | Level 4, grade C | |
| Ptacek J et al. Pain, coping and adjustment in patients with burns: preliminary findings from a prospective study. J Pain Symptom Manage 1995;10:446–55.5 | Level 2b, grade B | |
| Radnovich R et al. Acute pain: effective management requires comprehensive assessment. Postgrad Med 2014;126(4):59–72.25 | Level 5 grade D | |
| Rae CP et al. An audit of patient perception compared with medical and nursing staff estimation of pain during burn dressing changes.” Eur J Anaesthesiol 2000;17(1):43–5. | Level 4, grade C | |
| Ratcliff SL et al. The effectiveness of a pain and anxiety protocol to treat the acute pediatric burn patient. Burns 2006;32(5):554–62. | Level 3b, grade C | |
| Richardson P, Mustard L. The management of pain in the burns unit. Burns 2009;35(7):921–36. | Level 5, grade D | |
| Robert R et al. Anxiety: current practices in assessment and treatment of anxiety of burn patients. Burns 2000;26(6):549–52.26 | Level 4, grade C | |
| Shen J et al. Evaluation of nurse accuracy in rating procedural pain among pediatric burn patients using the Face, Legs, Activity, Cry, Consolability (FLACC) Scale. Burns 2017;43(1):114–20.27 | Level 2b, grade B | |
| Singer AJ et al. Association between burn characteristics and pain severity. Am J Emerg Med 2015;33(9):1229–31. | Level 3b, grade C | |
| Springborg AD et al. Effects of target-controlled infusion of high-dose naloxone on pain and hyperalgesia in a human thermal injury model: a study protocol: a randomized, double-blind, placebo-controlled, crossover trial with an enriched design. Medicine 2016;95(46):e5336. | Level 1b, grade A | |
| Stites M. Observational pain scales in critically ill adults. Crit Care Nurse 2013;33: 68–78. | Level 5, grade D | |
| Stoddard FJ et al. Treatment of pain in acutely burned children. J Burn Care Rehabil 2002;23(2):135–56. | Level 5, grade D | |
| Summer GJ et al. Burn injury pain: the continuing challenge. J Pain 2007;8(7):533–48. | Level 5, grade D | |
| Taal LA, Faber AW. The burn specific pain anxiety scale: introduction of a reliable and valid measure. Burns 1997;23(2):147–50.28 | Level 2b, grade B | |
| Taal LA et al. The abbreviated burn specific pain anxiety scale: a multicenter study. Burns 1999;25(6):493–7.29 | Level 2b, grade C | |
| Taverner T, Prince J. Acute neuropathic pain assessment in burn injured patients: a retrospective review. J Wound Ostomy Continence Nurs 2016;43(1):51–5.30 | Level 2b, grade C | |
| Topolovec-Vranic J et al. Validation and evaluation of two observational pain assessment tools in a trauma and neurosurgical intensive care unit. Pain Res Manag 2013;18(6):e107–14. | Level 5, grade D | |
| Turk DC et al. Analyzing multiple endpoints in clinical trials of pain treatments: IMMPACT recommendations. Initiative on methods, measurement, and pain assessment in clinical trials. Pain 2008;139(3):485–93. | Level 5, grade D | |
| Wasiak J et al. Inhaled methoxyflurane for pain and anxiety relief during burn wound care procedures: an Australian case series. Int Wound J 2014;11(1):74–8. | Level 4, grade C | |
| Weddell R. Improving pain management for patients in a hospital burns unit. Nurs Times 2004;100(11):38–40. | Level 5, grade D | |
| Weinberg K et al. Pain and anxiety with burn dressing changes: patient self-reports. J Burn Care Rehabil 2000;21:157–61.6 | Level 4, grade C | |
| Wibbenmeyer L. et al. An evaluation of factors related to postoperative pain control in burn patients. J Burn Care Res 2015;36(5):580–6.31 | Level 3b, grade C | |
| Wibbenmeyer L. et al. Evaluation of the usefulness of two established pain assessment tools in a burn population. J Burn Care Res 2011;32:52–60. | Level 3b, grade C | |
| Williams DA. The importance of psychological assessment in chronic pain. Curr Opin Urol 2013;23(6):554–9. | Level 5, grade D | |
| Yang CL, Wei ZR. Advances in the research of burn pain. Zhonghua Shao Shang Za Zhi 2017;33(1):61–4. | Level 5, grade D | |
| Yang HT et al. Improvement of burn pain management through routine pain monitoring and pain management protocol. Burns 2013;39(4):619–24.32 | Level 1b, grade A | |
| Pharmacologic Treatments |
||
| Opioid Pain Medication |
Altier N et al. Successful use of methadone in the treatment of chronic neuropathic pain arising from burn injuries: a case-study. Burns 2001;27(7):771–5. | Level 4, grade C |
| Andrews RM. Predictors of patient satisfaction with pain management and improvement 3 months after burn injury. J Burn Care Res 2012;33(3):442–52. | Level 2b, grade B | |
| Borland ML et al. Intranasal fentanyl is an equivalent analgesic to oral morphine in pediatric burns patients for dressing changes: a randomized double blind crossover study. Burns 2005;31(7):831–7.33 | Level 1b, grade B | |
| Chen L et al. Prediction of effect-site concentration of sufentanil by dose–response target controlled infusion of sufentanil and propofol for analgesic and sedation maintenance in burn dressing changes. Burns 2014;40(3):455–9.34 | Level 2b, grade B | |
| Corkery JM et al. The effects of methadone and its role in fatalities. Hum Psychopharmacol 2004;19:565–76. | Level 5, grade D | |
| Cuignet O et al. Effects of gabapentin on morphine consumption and pain in severely burned patients. Burns 2007;33(1):81–6. | Level 3b, grade C | |
| Finn J et al. A randomized crossover trial of patient controlled intranasal fentanyl and oral morphine for procedural wound care in adult patients with burns. Burns 2004;30(3):262–8.35 | Level 1b, grade B | |
| Foertsch CE et al. A quasi-experimental, dual-center study of morphine efficacy in patients with burns. J Burn Care Rehabil 1995;16(2 Pt 1):118–26.36 | Level 1b, grade A | |
| Gallagher G et al. The use of a target-controlled infusion of alfentanil to provide analgesia for burn dressing changes a dose finding study. Anesthesia 2000;55: 1159–63.37 | Level 4, grade C | |
| Grimsrud KN et al. Identification of cytochrome P450 polymorphisms in burn patients and impact on fentanyl pharmacokinetics: a pilot study. J Burn Care Res 2019;40(1):91–6.38 | Level 4, grade C | |
| Holtman JR Jr., Jellish WS. Opioid-induced hyperalgesia and burn pain. J Burn Care Res 2012;33(6):692–701. | Level 5, grade D | |
| Inturrisi CE. Pharmacology of methadone and its isomers. Minerva Anestesiol 2005;71:435–7. | Level 5, grade D | |
| Jones GM et al. Impact of early methadone initiation in critically injured burn patients: a pilot study. J Burn Care Res 2013;34:342–8.39 | Level 4, grade C | |
| Kim DE et al. A review of adjunctive therapies for burn injury pain during the opioid crisis. J Burn Care Res 2019;40(6):983–95.40 | Level 5, grade D | |
| Latarjet J, Choinère M. Pain in burn patients. Burns 1995;21(5):344–8. | Level 5, grade D | |
| Layson-Wolf C et al. Clinical use of methadone. J Pain Palliat Care Pharmacother 2002;16:29–59. | Level 5, grade D | |
| Le Floch R et al. Use of remifentanil for analgesia during dressing change in spontaneously breathing non-intubated burn patients. Ann Burns Fire Disasters 2006;19:136–9.41 | Level 4, grade C | |
| Lilleso J et al. Effect of peripheral morphine in a human model of acute inflammatory pain. Br J Anaesthe 2000;85(2):228–32. | Level 1b, grade B | |
| Linneman PK et al. The efficacy and safety of fentanyl for the management of severe procedural pain in patients with burn injuries. J Burn Care Rehabil 2000;216: 519–22.42 | Level 1b, grade B | |
| Long TD et al. Morphine-infused silver sulfadiazine (MISS) cream for burn analgesia: a pilot study. J Burn Care Rehabili 2001;22(2):118–23. | Level 2b, grade B | |
| Lugo RA et al. Pharmacokinetics of methadone. J Pain Palliat Care Pharmacother 2005;19:13–24. | Level 5, grade D | |
| Martin-Herz SP et al. Pediatric pain control practices of North American Burn Centers. J Burn Care Rehabili 2003;24(1):26–36. | Level 5, grade D | |
| McIntyre MK et al. Progress of clinical practice on the management of burn-associated pain: lessons from animal models. Burns 2016;42(6):1161–72. | Level 5, grade D | |
| McSherry T et al. Randomized, crossover study of immersive virtual reality to decrease opioid use during painful wound care procedures in adults. J Burn Care Res 2018;39(2):278–85. | Level 2b, grade B | |
| Ng JWG et al. Management of the lower gastrointestinal system in burn: a comprehensive review. Burns 2016;42(4):728–37. | Level 5, grade D | |
| Nilsson A et al. Patient controlled sedation using a standard protocol for dressing changes in burns: patients' preference, procedural details and a preliminary safety evaluation. Burns 2008;34(7):929–34.43 | Level 2b, grade B | |
| Okie S. A flood of opioids, a rising tide of deaths. N Engl J Med 2010;363(21): 1981–5. | Level 5, grade D | |
| Pardesi O et al. Pain Management in pediatric burn patients: review of recent literature and future directions. J Burn Care Res 2017;38(6):335–47. | Level 5, grade D | |
| Patterson DR et al. Baseline pain as a moderator of hypnotic analgesia for burn injury treatment. J Consul Clin Psychol 1997;65(1):60–7. | Level 2b, grade B | |
| Patterson DR et al. The 2002 Lindberg Award. PRN vs regularly scheduled opioid analgesics in pediatric burn patients. J Burn Care Rehabili 2002;23(6):424–30. | Level 3A, grade B | |
| Prakash S et al. Patient-controlled analgesia with fentanyl for burn dressing changes. Anesth Analg 2004;99(2):552–5. | Level 1b, grade B | |
| Ratcliff SL et al. The effectiveness of a pain and anxiety protocol to treat the acute pediatric burn patient. Burns 2006;32(5):554–62. | Level 4, grade C | |
| Retrouvey H, Shahrokhi S. Pain and the thermally injured patient-a review of current therapies. J Burn Care Res 2015;36(2):315–23.44 | Level 5, grade D | |
| Richardson P, Mustard L. The management of pain in the burns unit. Burns 2009;35(7):921–36. | Level 5, grade D | |
| Rittner HL et al. The clinical (ir)relevance of opioid-induced immune suppression. Curr Opin Anaesthesiol 2010;23(5):588–92. | Level 4, grade C | |
| Robert R et al. A double-blind study of the analgesic efficacy of oral transmucosal fentanyl citrate and oral morphine in pediatric patients undergoing burn dressing change and tubbing. J Burn Care Rehabili 2003;24:351–5.45 | Level 2b, grade C | |
| Schulte H et al. The synergistic effect of combined treatment with systemic ketamine and morphine on experimentally induced windup-like pain in humans. Anesth Analg 2004;98(6):1574–80. | Level 2b, grade B | |
| Shah H et al. Factors in the choice of oral transmucosal fentanyl citrate dose for adult burns dressings. Burns 2009;35(6):798–801.46 | Level 3b, grade C | |
| Sharar SR et al. A comparison of oral transmucosal fentanyl citrate and oral oxycodone for pediatric outpatient wound care. J Burn Care Rehabili 2002;23(1):27–31.47 | Level 2b, grade B | |
| Sharar SR et al. A comparison of oral transmucosal fentanyl citrate and oral hydromorphone for inpatient pediatric burn wound care analgesia. J Burn Care Rehabili 1998;19(6):516–21. | Level 2b, grade B | |
| Shelley K, Paech MJ. The clinical applications of intranasal opioids. Curr Drug Deliv 2008;5(1):55–8. | Level 5, grade D | |
| Sheridan R et al. Multi-center benchmarking study. Long-term posttraumatic stress symptoms vary inversely with early opiate dosing in children recovering from serious burns: effects durable at 4 years. J Trauma Acute Care Surg 2014;76(3):828–32.48 | Level 2b, grade B | |
| Seol TK et al. Propofol–ketamine or propofol-remifentanil for deep sedation and analgesia in pediatric patients undergoing burn dressing changes: a randomized clinical trial. Paediatr Anaesth 2015;25(6):560–6.49 | Level 2b, grade C | |
| Stein C, Küchler S. Non-analgesic effects of opioids: peripheral opioid effects on inflammation and wound healing. Curr Pharm Des 2012;18(37):6053–69. | Level 5, grade D | |
| Sullivan SR et al. “Opioid creep” is real and may be the cause of “fluid creep. Burns 2014;30(6):583–90. | Level 2b, grade C | |
| Thompson EM et al. Efficacy and safety of procedural sedation and analgesia for burn wound care. J Burn Care Res 2012;33(4):504–9. | Level 3b, grade C | |
| Trupkovic T et al. Analgesia and sedation in the intensive care of burn patients: results of a European survey. J Intensive Care Med 2011;26:397–407. | Level 5, grade D | |
| Webster LR. Risk factors for opioid-use disorder and overdose. Anesth Analg 2017;125(5):1741–8. | Level 5, grade D | |
| Welling A. A randomized controlled trial to test the analgesic efficacy of topical morphine on minor superficial and partial thickness burns in accident and emergency departments. Emerg Med J 2007;24(6):408–12. | Level 2a, grade B | |
| Wibbenmeyer L et al. The impact of opioid administration on resuscitation volumes in thermally injured patients. J Burn Care Res 2010;31(1):48–56. | Level 4, grade C | |
| Williams PI et al. Use of methadone in the morphine-tolerant burned paediatric patient. Br J Anaesth 1998;80:92–5.50 | Level 4, grade C | |
| Yang C et al. Efficacy and feasibility of opioids for burn analgesia: an evidence-based qualitative review of randomized controlled trials. Burns 2018;44(2):241–8. | Level 3b, grade C | |
| Zor F et al. Pain relief during dressing changes of major adult burns: ideal analgesic combination with ketamine. Burns 2010;36(4):501–5. | Level 3b, grade C | |
| Non-Opioid Medication | Asmussen S et al. A meta-analysis of analgesic and sedative effects of dexmedetomidine in burn patients. Burns 2013;39(4):625–31. | Level 2a, grade B |
| Bestard JA, Toth CC. An open-label comparison of nabilone and gabapentin as adjuvant therapy or monotherapy in the management of neuropathic pain in patients with peripheral neuropathy. Pain Practice 2011;11:353–68.51 | Level 4, grade C | |
| Canpolat DG et al. Ketamine-propofol vs ketamine-dexmedetomidine combinations in pediatric patients undergoing burn dressing changes. J Burn Care Res 2012;33(6):718–22.52 | Level 2b, grade B | |
| Carstensen M, Moller AM. Adding ketamine to morphine for intravenous patient-controlled analgesia for acute postoperative pain: a qualitative review of randomized trials. Br J Anaesth 2010;104(4):401–6. | Level 2a, grade B | |
| Cashman JN. The mechanisms of action of NSAIDs in analgesia. Drugs 1996;52(Suppl 5):13–23.53 | Level 5, grade D | |
| Coimbra C et al. Patient-controlled sedation using propofol for dressing changes in burn patients: a dose-finding study. Anesth Analg 2003;97(3):839–42. | Level 4, grade C | |
| Cuignet O et al. Effects of gabapentin on morphine consumption and pain in severely burned patients. Burns 2007;33(1):81–86.54 | Level 3b, grade C | |
| Davis KD et al. Cutaneous pretreatment with the capsaicin analog NE-21610 prevents the pain to a burn and subsequent hyperalgesia. Pain 1995;62(3):373–8. | Level 4, grade C | |
| Desai C et al. Effectiveness of a topical local anesthetic spray as analgesia for dressing changes: a double-blinded randomized pilot trial comparing an emulsion with an aqueous lidocaine formulation. Burns 2014;40(1):106–12. | Level 1b, grade B | |
| Dworkin RH et al. Pharmacologic management of neuropathic pain: evidence-based recommendations. Pain 2007;132(3):237. | Level 5, grade D | |
| Edrich T et al. Ketamine for long-term sedation and analgesia of a burn patient. Anesth Analg 2004;99(3):893–5.55 | Level 5 grade D | |
| Everett JJ et al. Adjunctive interventions for burn pain control: comparison of hypnosis and ativan: the 1993 Clinical Research Award. J Burn Care Rehabili 1993;14(6):676–83. | Level 4, grade C | |
| Frank B et al. Comparison of analgesic effects and patient tolerability of nabilone and dihydrocodeine for chronic neuropathic pain: randomized, crossover, double blind study. BMJ 2008;336:199–201.56 | Level 1b, grade B | |
| Graham GG, Scott KF. Mechanisms of action of paracetamol. Am J Ther 2006;12: 46–55.57 | Level 5, grade D | |
| Gray P et al. Pregabalin in severe burn injury pain: a double-blind, randomized placebo-controlled trial. Pain 2011;152(6):1279–88.58 | Level 1b, grade B | |
| Gray P et al. Successful use of gabapentin in acute pain management following burn injury: a case series. Pain Med 2008;9(3):371–6.59 | Level 4, grade C | |
| Green DP et al. Role of endogenous TRPV1 agonists in a postburn pain model of partial-thickness injury. Pain 2013;154(11):2512–20. | Level 2b, grade B | |
| Hansen SL et al. A retrospective study on the effectiveness of intranasal midazolam in pediatric burn patients. J Burn Care Rehabili 2001;22(1):6–8. | Level 4, grade C | |
| Heinrich M et al. Conscious sedation: off-label use of rectal S(+)-ketamine and midazolam for wound dressing changes in paediatric heat injuries. Eur J Pedia Surg 2004;14(4):235–9. | Level 4, grade C | |
| Jonsson A et al. Inhibition of burn pain by intravenous lignocaine infusion. Lancet 1991;338(8760):151–2. | Level 4, grade C | |
| Kariya N et al. Oral clonidine for sedation and analgesia in a burn patient. J Clin Anesth 1998;10(6):514–7. | Level 4, grade C | |
| Kaul I et al. Use of gabapentin and pregabalin for pruritus and neuropathic pain associated with major burn injury: a retrospective chart review. Burns 2018;44(2): 414–22. | Level 4, grade C | |
| Kaur S et al. Effect of intraoperative infusion of low-dose ketamine on management of postoperative analgesia. J Nat Sci Biol Med 2015;6:378–82.60 | Level 2b, grade B | |
| Kundra P et al. Oral ketamine and dexmedetomidine in adults' burns wound dressing—A randomized double blind cross over study. Burns 2013;39(6): 1150–6.61 | Level 1b, grade B | |
| Lee JJ et al. Effectiveness of nalbuphine for relief of burn debridement pain. J Burn Care Rehabili 1989;10(3):241–6. | Level 2b, grade B | |
| Lu S et al. A double blind placebo control pilot study on the safety and tolerability of Nabilone in marijuana users. Mental Health Subs Use 2013;6:133–9. | Level 2b, grade B | |
| Loftus RW et al. Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery. Anesthesiology 2010;113:639–46. 62 | Level 1b, grade B | |
| Lyons B et al. Pain relief with low-dose intravenous clonidine in a child with severe burns. Intensive Care Med 1996;22(3):249–51.63 | Level 5, grade D | |
| Maani CV et al. Combining ketamine and virtual reality pain control during severe burn wound care: one military and one civilian patient. Pain Med 2011;12(4):673–8. | Level 5, grade D | |
| MacPherson RD et al. Ketamine and midazolam delivered by patient-controlled analgesia in relieving pain associated with burns dressings. Clin J Pain 2008;24(7): 568–71.64 | Level 4, grade C | |
| Marinangeli F et al. Clonidine for treatment of postoperative pain: a dose-finding study. Eur J Pain 2002;6:35–42.65 | Level 1b, grade B | |
| Martin E et al. The role of the alpha2-adrenoceptor agonist dexmedetomidine in postsurgical sedation in the intensive care unit. J Intensive Care Med 2003;18: 29–41.66 | Level 1b, grade A | |
| McGuinness SK et al. A systematic review of ketamine as an analgesic agent in adult burn injuries. Pain Med 2011;12(10):1551–8.67 | Level 2a, grade B | |
| Meyer WJ, 3rd et al. Acetaminophen in the management of background pain in children post-burn. J Pain Symptom Manage 1997;13(1):50–5.68 | Level 4, grade C | |
| Nauta M et al. Codeine-acetaminophen versus nonsteroidal anti-inflammatory drugs in the treatment of post-abdominal surgery pain: a systematic review of randomized trials. Am J Surg 2009;198(2):256–61.69 | Level 1a, grade A | |
| Norambuena C et al. Oral ketamine and midazolam for pediatric burn patients: a prospective, randomized, double-blind study. J Pediatr Surg 2013;48(3):629–34. | Level 1b, grade A | |
| Orrey DC et al. Results of a pilot multicenter genotype-based randomized placebo-controlled trial of propranolol to reduce pain after major thermal burn injury. Clin J Pain 2015;31(1):21–9. | Level 1a, grade A | |
| Owens VF et al. Ketamine: a safe and effective agent for painful procedures in the pediatric burn patient. J Burn Care Res 2006;27(2):211–6.70 | Level 4, grade C | |
| Pal SK et al. Adjunctive methods of pain control in burns. Burns 1997;23:404–12.71 | Level 5, grade D | |
| Pedersen JL et al. Topical glucocorticoid has no antinociceptive or anti-inflammatory effect in thermal injury. Br J Anaesth 1994;72(4):379–82. | Level 1b, grade B | |
| Pichot C et al. Dexmedetomidine and clonidine: from second- to first-line sedative agents in the critical care setting? J Intensive Care Med 2012;27:219–37.72 | Level 5, grade D | |
| Promes JT et al. A prospective, multicenter, randomized, double-blind trial of IV ibuprofen for treatment of fever and pain in burn patients. J Burn Care Res 2011;32(1):79–90.73 | Level 2b, grade B | |
| Retrouvey H, Shahrokhi S. Pain and the thermally injured patient-a review of current therapies. J Burn Care Res 2015;36(2):315–23.44 | Level 5, grade D | |
| Shank ES et al. Hemodynamic responses to dexmedetomidine in critically injured intubated pediatric burned patients: a preliminary study. J Burn Care Res 2013;34(3):311–17.74 | Level 4, grade C | |
| Springborg AD et al. Effects of target-controlled infusion of high-dose naloxone on pain and hyperalgesia in a human thermal injury model: a study protocol: a randomized, double-blind, placebo-controlled, crossover trial with an enriched design. Medicine 2016;95(46):e5336. | Level 1b, grade B | |
| Tran HT et al. Intravenous ketorolac for pain management in a ventilator-dependent patient with thermal injury. Pharmacotherapy 1996;16(1):75–8.75 | Level 5, grade D | |
| Tryba M, Gehling M. Clonidine—a potent analgesic adjuvant. Curr Opin Anaesthesiol 2002;15:511–7. 76 | Level 5, grade D | |
| Turcotte D et al. Examining the roles of cannabinoids in pain and other therapeutic indications: a review. Expert Opin Pharmaco 2010;11:17–31.77 | Level 2a, grade B | |
| Wasiak J et al. Intravenous lidocaine for the treatment of background or procedural burn pain. Cochr Datab Syst Rev 2012;6:CD005622.78 | Level 1a, grade A | |
| Webb AR et al. The addition of a small-dose ketamine infusion to tramadol for postoperative analgesia: a double-blinded, placebo-controlled, randomized trial after abdominal surgery. Anesth Analg 2007;104:912–7.79 | Level 1b, grade B | |
| Werner MU et al. Analgesic effects of dexamethasone in burn injury. Reg Anesth Pain Med 2002;27(3):254–60. | Level 1b, grade B | |
| Wibbenmeyer L et al. Gabapentin is ineffective as an analgesic adjunct in the immediate postburn period. J Burn Care Res 2014;35(2):136–42. 80 | Level 1b, grade B | |
| Wong L, Turner L. Treatment of post-burn neuropathic pain: evaluation of pregablin. Burns 2010;36:769–72.81 | Level 4, grade C | |
| Zhang J et al. Effects of puerarin on the inflammatory role of burn-related procedural pain mediated by P2X(7) receptors. Burns 2013;39(4):610–8. | Level 3b, grade C | |
| Zor F. et al. Pain Relief during dressing changes of major adult burns: ideal analgesic combination with Ketamine. Burns 2010;36(4): 501–5.82 | Level 2b, grade B | |
| Regional Anesthesia |
Ashburn MA. Burn pain: the management of procedure-related pain. J Burn Care Rehabil 1995;16(3 pt 2):365–71. | Level 5, grade D |
| Burd A, Ahmed K. Staged serial debridement and one stage grafting under local anesthesia. a bed side procedure. Burns 2010;36(4):588–9. | Level 5, grade D | |
| Bussolin L et al. Tumescent local anesthesia for the surgical treatment of burns and postburn sequelae in pediatric patients. Anesthesiology 2003;99(6):1371–5. 83 | Level 2b, grade B | |
| Bussolin L et al. Plasma levels of lignocaine during tumescent local anesthesia in children with burns. Anaesth Intens Care 2010;38(6):1008–12.84 | Level 3b, grade C | |
| Cuignet O et al. The efficacy of continuous fascia iliaca compartment block for pain management in burn patients undergoing skin grafting procedures. Anesth Analg 2004;98(4):1077–81.85 | Level 1b, grade B | |
| Cuignet O et al. The long-term analgesic efficacy of a single-shot fascia iliaca compartment block in burn patients undergoing skin-grafting procedures. J Burn Care Rehabil 2005;26(5):409–15.86 | Level 1b, grade B | |
| Dahl JB et al. The effect of pre- versus postinjury infiltration with lidocaine on thermal and mechanical hyperalgesia after heat injury to the skin. Pain 1993;53(1):43–51. | Level 3b, grade C | |
| Gupta A et al. A study of regional nerve blocks and local anesthetic creams (Prilox) for donor sites in burn patients. Burns 2007;33(1):87–91. | Level 3b, grade C | |
| Harbin KR, Norris TE. Anesthetic management of patients with major burn injury. AANA J 2012;80(6):430–9. | Level 5, grade D | |
| Janezic TF. Skin grafting of full thickness burns under local anesthesia with EMLA cream. Burns 1998;24(3):259–63.87 | Level 5, grade D | |
| Jellish WS et al. Effect of topical local anesthetic application to skin harvest sites for pain management in burn patients undergoing skin-grafting procedures. Ann Surg 1999;229(1):115–20. 88 | Level 2b, grade B | |
| Kestenbaum AD et al. Doppler-guided axillary block in a burn patient. Anesthesiology 1990;73(3):586–7. | Level 5, grade D | |
| Mago V, Prasad M. Tumescent local anesthesia for release of postburn neck contractures. J Burn Care Res 2009;30(6):1049. | Level 5, grade D | |
| Mora AG et al. En route use of analgesics in nonintubated, critically ill patients transported by U.S. Air Force critical care air transport teams. Mil Med 2016; 181(5 Suppl):145–51. | Level 4, grade C | |
| Pardesi O, Fuzaylov G. Pain management in pediatric burn patients: review of recent literature and future directions. J Burn Care Res 2017;38(6):335–47. | Level 4, grade C | |
| Pedersen JL et al. Effect of preemptive nerve block on inflammation and hyperalgesia after human thermal injury. Anesthesiology 1996;84(5):1020–6. 89 | Level 4, grade C | |
| Prasad MK et al. Severe post-burn neck contracture release and skin graft harvest using tumescent local anesthesia as the sole anesthetic technique. J Anesth 2012;26(1):97–99.90 | Level 5, grade D | |
| Prasetyono TO, Koswara AF. Linear hand burn contracture release under local anesthesia without tourniquet. Hand Surg 2015;20(3):484–7. | Level 5, grade D | |
| Randalls B. Continuous brachial plexus blockade. a technique that uses an axillary catheter to allow successful skin grafting. Anaesthesia 1990;45(2):143–4. | Level 5, grade D | |
| Shank ES et al. Ultrasound-guided regional anesthesia for pediatric burn reconstructive surgery: a prospective study. J Burn Care Res 2016;37(3):e213–7.91 | Level 5, grade D | |
| Shick V et al. The benefits of ultrasound-guided continuous sensory nerve blockade in the setting of burn injury: a case report of bilateral continuous superficial peroneal nerve blockade in a patient with severe sleep apnea. J Clin Anesth 2017;36:62–6. | Level 5, grade D | |
| Shteynberg A et al. Ultrasound guided lateral femoral cutaneous nerve (LFCN) block: safe and simple anesthesia for harvesting skin grafts. Burns 2013;39(1):146–9.92 | Level 3b, grade C | |
| Wasiak J et al. Adjuvant use of intravenous lidocaine for procedural burn pain relief: a randomized double blind, placebo-controlled, crossover trial.” Burns 2011;37: 951–7.77 | Level 1b, grade B | |
| Non-Pharmacologic Treatments | ||
| General |
de Jong AEE et al. Nonpharmacological nursing interventions for procedural pain relief in adults with burns: a systematic literature review. Burns 2007;33:811–27.93 | Level 3a, grade B |
| Everett JJ et al. Cognitive and behavioral treatments for burn pain. Pain Clin 1990;3:133–45. | Level 5, grade D | |
| Fauerbach JA et al. Coping with the stress of a painful medical procedure. Behav Res Ther 2002;40(9):1003–15.94 | Level 1b, grade A | |
| Hanson MD et al. Nonpharmacological interventions for acute wound care distress in pediatric patients with burn injury: a systematic review. J Burn Care Res 2008;29:730–41.95 | Level 2b, grade B | |
| Martin-Herz SP et al. Psychological principles of burn wound pain in children: part II: treatment applications. J Burn Care Rehabil 2000;21(5):458–72. | Level 5, grade D | |
| Scheffler M et al. Efficacy of non-pharmacological interventions for procedural pain relief in adults undergoing burn wound care: a systematic review and meta-analysis of randomized controlled trials. Burns 2018;44(7):1709–20.96 | Level 1a, grade A | |
| Thurber CA et al. Psychological principles of burn wound pain in children: part I: theoretical framework. J Burn Care Rehabil 2000; 21(4):376–87. | Level 5, grade D | |
| Hypnosis |
Askay SW et al. A randomized controlled trial of hypnosis for burn wound care. Rehabili Psychol 2007;52:247–53. | Level 1b, Grade A |
| Berger MM et al. Impact of a pain protocol including hypnosis in major burns. Burns 2010;36(5):639–46.97 | Level 2c, Grade B | |
| Chester SJ et al. Effectiveness of medical hypnosis for pain reduction and faster wound healing in pediatric acute burn injury: study protocol for a randomized controlled trial. Trials 2016;17(1):223.98 | Level 5, grade D | |
| Everett JJ et al. Adjunctive interventions for burn pain control: comparison of hypnosis and ativan: the 1993 Clinical Research Award. J Burn Care Rehabili 1993;14(6):676–83. | Level 2b, grade B | |
| Frenay MC et al. Psychological approaches during dressing changes of burned patients: a prospective randomized study comparing hypnosis against stress reducing strategy. Burns 2001;27(8):793–9. | Level 1b, grade B | |
| Patterson DR et al. Hypnotherapy as a treatment for pain in patients with burns: research and clinical considerations. J Burn Care Rehabil 1987;8:263–8. | Level 3a, grade B | |
| Patterson DR et al. Hypnosis for the treatment of burn pain. J Consul Clin Psychol 1992;60:713–7.99 | Level 2b, grade B | |
| Patterson DR, Ptacek JT. Baseline pain as a moderator of hypnotic analgesia for burn injury treatment. J Consul Clin Psychol. 1997;65:60–7. | Level 2b, grade B | |
| Patterson DR, Jensen M. Hypnosis and Clinical Pain. Psychol Bull 2003;129:495–521. | Level 5, grade D | |
| Patterson DR et al. Factors predicting hypnotic analgesia in clinical burn pain. Int J Clin Exper Hypn 1997;45:377–95. | Level 5, grade D | |
| Patterson DR et al. Hypnotherapy as an adjunct to narcotic analgesia for the treatment of pain for burn debridement. Amer J Clin Hypn 1989;31:156–63. | Level 3b, grade C | |
| Patterson DR et al. Virtual reality hypnosis: a case report. Int J Clin Exp Hypn 2004;52:27–38. | Level 4, grade C | |
| Patterson D et al. Hypnosis delivered through immersive virtual reality for burn pain. Int J Clin Exp Hypn 2006;54(2):130–42. | Level 3b, grade B | |
| Shakibaei F et al. Hypnotherapy in managemnet of pain and reexperiencing of trauma in burn patients. Int J Clin Exp Hypn 2008;56(2):185–97. | Level 1b, grade B | |
| Van der Does AJ et al. Hypnosis and pain in patients with severe burns: a pilot study. Burns 1988;14(5):399–404.100 | Level 4, grade C | |
| Distraction Techniques/Virtual Reality |
Brown NJ et al. Efficacy of a children's procedural preparation and distraction device on healing in acute burn wound care procedures: study protocol for a randomized controlled trial. Trials 2012;13:238. 101 | Level 5, grade D |
| Brown NJ et al. Play and heal: randomized controlled trial of DittoTM intervention efficacy on improving re-epithelialization in pediatric burns. Burns 2014;40(2): 204–13.102 | Level 2b, grade B | |
| Carrougher GJ et al. The effect of virtual reality on pain and range of motion in adults with burn injuries. J Burn Care Rehabil 2009;30(5):785–91. 103 | Level 1b, grade A | |
| Chan E et al. Application of a virtual reality prototype for pain relief of pediatric burn in Taiwan. J Clin Nurs 2007;16(4):786–93.104 | Level 4, grade C | |
| Das DA et al. The efficacy of playing a virtual reality game in modulating pain for children with acute burn injuries: a randomized controlled trial. BMC Pediat 1995;5(1):1.105 | Level 2b, grade B | |
| Eccleston C, Crombez G. Pain demands attention: a cognitive-affective model of the interruptive function of pain. Psychol Bull 1999;125:356–66.106 | Level 5, grade D | |
| Hoffman H et al. Virtual reality pain control during burn wound debridement in the hydrotank. Clin J Pain 2008;24(4):299–304.107 | Level 3b, grade B | |
| Hoffman HG et al. Water-friendly virtual reality pain control during wound care. J Clin Psychol 2004;60(2):189–95.108 | Level 4, grade C | |
| Hoffman HG et al. Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: a controlled study. Clin J Pain 2000;16: 244–50.109 | Level 3b, grade B | |
| Hoffman HG et al. Virtual reality as an adjunctive pain control during burn wound care in adolescent patients. Pain 2000;85(1–2):305–9.110 | Level 4, grade C | |
| Konstantatos AH et al. Predicting the effectiveness of virtual reality relaxation on pain and anxiety when added to PCA morphine in patients having burns dressings changes. Burns 2009;35(4):491–9. | Level 1b, grade A | |
| Maani C et al. Pain control during wound care for combat-related burn injuries using custom, articulated arm-mounted virtual reality goggles. J Cyberther Rehabil 2008;1(2):193–8.111 | Level 4, grade C | |
| Miller AC et al. A distraction technique for control of burn pain. J Burn Care Rehabili 1992;22(2):144–9.112 | Level 2b, grade B | |
| Miller K et al. Multi-modal distraction. Using technology to combat pain in young children with burn injuries. Burns 2010;36(5):647–58. 113 | Level 2b, grade B | |
| Morris LD et al. The effectiveness of virtual reality on reducing pain and anxiety in burn injury patients. Clin J Pain 2009;25(9):815–26.114 | Level 2a, grade B | |
| Morris LD et al. Feasibility and potential effect of a low-cost virtual reality system on reducing pain and anxiety in adult burn injury patients during physiotherapy in a developing country. Burns 2010;36(5):659–64.115 | Level 4, grade C | |
| Mott J et al. The efficacy of an augmented virtual reality system to alleviate pain in children undergoing burns dressing changes: a randomized controlled trial. Burns 2008;34(6):803–8.116 | Level 1b, grade A | |
| Park E et al. The effects of relaxation breathing on procedural pain and anxiety during burn care. Burns 2013;39(6):1101–6. | Level 2c, grade B | |
| Schmitt YS et al. A randomized, controlled trial of immersive virtual reality analgesia, during physical therapy for pediatric burns. Burns 2011;37(1):61–8.117 | Level 1b, grade A | |
| Sharar S et al. Factors influencing the efficacy of virtual reality distraction analgesia during postburn physical therapy: preliminary results from 3 ongoing studies. Arch Phys Med Rehabili 200788(12 Suppl 2):S43–9.118 | Level 3b, grade B | |
| Slater M,Wibur S. A framework for immersive virtual environments (FIVE): speculations on the role of presence in virtual environments. Presence 1997;6:603–16.119 | Level 5, grade D | |
| Small C et al. Virtual restorative environment therapy as an adjunct to pain control during burn dressing changes: study protocol for a randomized controlled trial. Trials 2015;16:329. | Level 4, grade C | |
| van Twillert B et al. Computer-generated virtual reality to control pain and anxiety in pediatric and adult burn patients during wound dressing changes. J Burn Care Res 2007;28(5):694–702.120 | Level 1b, grade B | |
| Music |
Ferguson SL, Voll KV. Burn pain and anxiety: the use of music relaxation during rehabilitation. J Burn Care Rehabili 2004;25(1):8–14. | Level 3b, grade B |
| Fratianne RB et al. The effect of music-based imagery and musical alternate engagement on the burn debriedement process. J Burn Care Rehabil 2001;22(1):47–53. | Level 2c, grade B | |
| Hsu KC et al. Effect of music intervention on burn patients' pain and anxiety during dressing changes. Burns 2016;42(8):1789–96.121 | Level 2b, grade B | |
| Presner JD et al. Music therapy for assistance with pain and anxiety management in burn treatment. J Burn Care Rehabil 2001;22(1):83–8. | Level 5, grade D | |
| Tan X et al. The efficacy of music therapy protocols for decreasing pain, anxiety, and muscle tension levels during burn dressing changes: a prospective randomized crossover trial. J Burn Care Res 2010;31(4):590–7.122 | Level 2b, grade B | |
| Whitehead-Pleaux AM et al. The effects of music therapy on pediatric patients' pain and anxiety during donor site dressing change. J Music Ther 2006;43(2):136–53. | Level 2b, grade C | |
| Whitehead-Pleaux AM et al. Exploring the effects of music therapy on pediatric pain: phase 1. J Music Ther 2007;44(3):217–41. | Level 2c, grade C | |
| Relaxation |
Choi J et al. Aromatherapy for the relief of symptoms in burn patients: a systematic review of randomized controlled trials. Burns 2017;44(6):1395–402.123 | Level 3a, grade B |
| Knudson-Cooper MS. Relaxation and biofeedback training in the treatment of severely burned children. J Burn Care Rehabil 1981;2(2):102–110. | Level 2b, grade C | |
| Wernick RL et al. Pain management in severely burned adults: a test of stress inoculation. J Behav Med 1981;4(1):103–9. | Level 2c, grade C | |
| Massage |
Field T et al. Post-burn itching, pain, and psychological symptoms are reduced with massage therapy. J Burn Care Rehabil 2000;21(3):189–93. | Level 2b, grade C |
| Field T et al. Burn injuries benefit from massage therapy. J Burn Care Rehabil 1998;19(3):241–4. | Level 2b, grade C | |
| Hernandez-Reif M et al. Childrens’ distress during burn treatment is reduced by massage therapy. J Burn Care Rehabili 2011;22:191–5.124 | Level 2b, grade C | |
| Parlak Gurol A et al. Itching, pain, and anxiety levels are reduced with massage therapy in burned adolescents.” J Burn Care Res 2010;31(3):429–32.125 | Level 2c, grade B | |
| Seyyed-Rasooli A et al. Comparing the effects of aromatherapy massage and inhalation aromatherapy on anxiety and pain in burn patients: a single-blind randomized clinical trial. Burns 2016;42(8):1774–80.126 | Level 1b, grade B |