Not all pain is created equal. Depending on its source, severity, and circumstance, different types of pain require different treatments. In this series, WEX Pharmaceuticals will discuss different causes of pain and how they are treated. Here, we will be discussing burn pain.
Burns are some of the most common – and painful – injuries a person can suffer. From having a day at the beach without sunscreen to being scalded with boiling water, burns happen with frustrating regularity. When they occur, they can cause significant, long-lasting pain. As burns differ widely in terms of both cause and severity, there can be different approaches taken to best alleviate this pain. In this article, we will delve into the particularities of burn pain, and how it is treated.
What causes burn pain
Inside the skin, there are sensory neurons known as nociceptors. They are responsible for detecting harmful stimuli to the body. When skin is burned, tissue damage leads to inflammatory mediators being released by the body, activating the nociceptors. Thermal nociceptors interpret temperatures above 42 degrees Celsius[1] as painful, while chemical and mechanical nociceptors interpret the physical and chemical changes that accompany it. This causes the sensitized nociceptors to transmit pain signals. This can cause increased sensitivity at the injury site (primary hyperalgesia) and the surrounding area (secondary hyperalgesia).
Why burn pain is so tricky to treat
Due to the myriad of ways burns can affect the body, burn pain is often difficult to treat. From the lowest severity (1st degree) to the highest (4th), burns can be exceedingly painful, and these painful effects can last throughout the healing process and beyond. Here are just some of the reasons treating burn pain can be so complex:
Varied nature of burns
Burn injuries can vary widely in terms of their severity and depth. First degree burns may only affect the outermost layer of skin (the epidermis), while third and fourth degree burns can cause deep tissue damage down to the layers of muscle and bone. The diverse nature of burns requires different approaches to manage their pain. Including surgery, skin grafts, and rehabilitation therapy.
Nerve Damage
Burn injuries – particularly third and fourth degree burns – often involve damage to nerve endings in the affected area. This nerve damage can lead to neuropathic pain. Neuropathic pain, which is characterized by shooting, burning sensations, is not tied to nociceptive signals,[2] and is very challenging to manage with conventional pain medications.
Medical response and the psychological impact
Unfortunately, burn treatments can sometimes exacerbate burn pain. Burn injuries often require frequent wound care and dressing changes, which can be extremely painful for patients.[3] On top of this, surgery and procedures such as skin grafts may also be in order, which result in additional pain, discomfort, and anxiety for patients, adding to the psychological toll.
Because of these and other factors, treating burn pain can be a challenging endeavour. Here are just some of the treatments prescribed for burn pain:
Over-the-counter NSAIDs and traditional remedies
For minor burns, time, home remedies and over the counter medication can often be the best course of action. Applying cooling packs to minor burns can reduce inflammation and pain. For medications, Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen or Naproxen can have a similar effect. Often, first degree burns do not require serious medical attention, and these practical solutions can help with managing the pain.
Opioids
For severe burns, opioids are often prescribed to alleviate pain. While effective at managing pain, opioid side effects are not to be taken lightly. These side effects include respiratory issues, addiction, and in rare cases, opioid-induced hyperalgesia,[4] wherein nociceptors become sensitized to opioid exposure, resulting in patient pain becoming heightened rather than alleviated.
Antiepileptics
As mentioned, neuropathic pain can be a significant concern for burn patients, as traditional analgesics may not be effective. Antiepileptics such as Gabapentin have achieved success in providing some relief to neuropathic pain.
Of course, these are just some of the medications and treatments that have been prescribed for burn pain. There are many treatments medical professionals have prescribed for burn pain, from anxiolytics to lower burn victims’ anxieties, to newer treatments such as ketamine therapy and non-opioid analgesics. In truth, the best course of action for treating burn pain is often largely dependent on the patient and their needs. Treating burn pain is not always simple, but with the right steps, medications, and advice, it can be effectively managed.
[1] James, D. L., & Jowza, M. (2017). Principles of Burn Pain Management. Clinics in Plastic Surgery, 44(4), 737–747. https://doi.org/10.1016/j.cps.2017.05.005
[2] Ibid.
[3] Wiechman Askay, S., Patterson, D. R., Sharar, S. R., Mason, S., & Faber, B. (2009). Pain Management in Patients with Burn Injuries. International Review of Psychiatry, 21(6), 522–530. https://doi.org/10.3109/09540260903343844
[4] James, D. L., & Jowza, M. (2017). Principles of Burn Pain Management. Clinics in Plastic Surgery, 44(4), 737–747. https://doi.org/10.1016/j.cps.2017.05.005
