Management of Skin Tightness and Pain Due to Old Burns
For managing skin tightness and pain from old burn scars, a multimodal approach combining pharmacological and non-pharmacological interventions is strongly recommended, with acetaminophen as the first-line medication and physical therapy techniques to improve mobility and reduce contractures. 1, 2
Pharmacological Management
First-Line Medications
- Regular acetaminophen: Recommended as the primary pharmacological intervention for burn-related pain 1
- Safe and effective for long-term management
- Can be administered on a scheduled basis rather than as needed
Additional Pain Management Options
- NSAIDs: Consider adding for more severe pain, but carefully evaluate risks in elderly patients or those with comorbidities 1
- Multimodal analgesia: Combine different medication classes for better pain control 1
- Titrate all medications based on validated pain assessment scales
- Avoid or minimize opioid use: Only use for breakthrough pain at the lowest effective dose for the shortest period 1
- High risk of side effects, especially in elderly patients
Non-Pharmacological Interventions
Physical Therapy Approaches
- Regular stretching exercises: To improve flexibility and reduce contractures
- Massage therapy: To soften scar tissue and improve circulation
- Compression garments: May help reduce hypertrophic scarring and tightness 2
Topical Treatments
- Moisturizers: Apply regularly to keep scar tissue hydrated
- Vegetable oil-based products can provide longer-term relief 2
- Silicone gel sheets/ointments: May help soften and flatten hypertrophic scars
Other Supportive Measures
- Cooling techniques: For acute flare-ups of pain or inflammation 2
- Protective dressings: For areas prone to breakdown or irritation 2
Special Considerations
For Severe or Refractory Cases
- Referral to specialized burn center: Consider for cases not responding to standard management 2
- Surgical options: May be necessary for severe contractures limiting function
- Scar revision
- Z-plasty
- Skin grafting
Monitoring and Follow-up
- Regular evaluation: Assess for signs of infection or breakdown
- Pain assessment: Use validated scales to monitor effectiveness of interventions
Common Pitfalls to Avoid
- Inadequate moisturization: Dry scar tissue is more prone to cracking and pain
- Overreliance on opioids: Can lead to dependence without addressing underlying issues
- Neglecting physical therapy: Movement is essential to prevent worsening contractures
- Using home remedies like butter: These can worsen scarring and increase infection risk 2
By implementing this comprehensive approach to managing old burn scars, patients can experience significant improvement in both pain control and functional outcomes, enhancing their quality of life and preventing further complications.