From the Guidelines
To control persistent burn pain, a multimodal approach should be used, combining analgesics such as titrated intravenous ketamine with other medications, and non-pharmacological techniques like cooling and covering the burn with a fatty substance, as recommended by experts in the field 1.
Key Considerations
- The use of written protocols for pain management and regular assessment is crucial in controlling burn pain, as it can be intense and difficult to treat 1.
- Titrating drugs is essential to reduce the risk of under- and overdosing, especially in burn patients who may experience hypovolaemia and increased risk of adverse effects from analgesics or sedative drugs 1.
- Non-pharmacological treatments, such as virtual reality or hypnosis techniques, may also be effective in reducing pain intensity and anxiety in burn patients 1.
Medication Options
- Over-the-counter analgesics like acetaminophen or NSAIDs are generally recommended for burn pain, with a study showing no significant incidence of serious adverse events with IV ibuprofen 1.
- Ketamine is an effective drug for burn-induced pain and can limit morphine consumption, making it a valuable option in a multimodal approach 1.
Wound Care
- Gently cleaning the area with cool water and mild soap, applying an antibiotic ointment, and covering with a non-stick bandage can help reduce pain and support the healing process.
- Cold compresses (not ice directly on the skin) for 15-20 minutes several times daily can also reduce pain and inflammation.
When to Seek Medical Attention
- Moderate to severe burns with persistent pain, or those covering large areas, affecting sensitive areas, or showing signs of infection, require immediate medical attention, as they may necessitate prescription-strength pain medications or specialized burn treatments 1.
From the FDA Drug Label
CLINICAL PHARMACOLOGY Ketamine is a rapid-acting general anesthetic producing an anesthetic state characterized by profound analgesia, normal pharyngeal-laryngeal reflexes, normal or slightly enhanced skeletal muscle tone, cardiovascular and respiratory stimulation, and occasionally a transient and minimal respiratory depression Specific areas of application have included the following: debridement, painful dressings, and skin grafting in burn patients, as well as other superficial surgical procedures
To control burn pain that persists, ketamine can be used due to its profound analgesic properties. It is suitable for procedures such as debridement, painful dressings, and skin grafting in burn patients 2.
From the Research
Burn Pain Management
To control burn pain that persists, several options can be considered:
- Pain assessment: Accurate assessment of burn pain is crucial for effective management, as stated in the American Burn Association guidelines 3.
- Opioid medications: Opioids can be used to manage burn pain, but their use should be carefully considered due to the risk of overdose and addiction 3, 4.
- Nonopioid medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen can be effective alternatives to opioids for managing acute pain, including burn pain 4.
- Combination therapy: Using a combination of opioid and nonopioid pain relievers can be an effective way to manage burn pain while reducing opioid consumption 4.
- Regional anesthesia: Regional anesthesia can be used to manage burn pain, especially in severe cases 3.
- Nonpharmacologic treatments: Nonpharmacologic treatments, such as wound care and physical therapy, can also be effective in managing burn pain 3.
Medication Compatibility
When using multiple medications to manage burn pain, it is essential to consider their compatibility:
- Intravenous acetaminophen can be safely mixed with morphine, fentanyl, and ketamine in concentrations commonly used in pediatric settings 5.
- The compatibility of these medications can help simplify pain management regimens and reduce the need for multiple intravenous lines.