Multimodal Regimen Crucial for Treating Burn Injury-Induced Pain
Experts gathered to explore the pathophysiology and therapeutic management of burn injury-induced pain.
A multimodal pain regimen, featuring a blend of pharmacologic and nonpharmacologic agents, is significantly important in treating patients with burn injury-induced pain (BIP), according to a study published in Burns Open.1 Despite opioids being a centerpiece of burn pain management, adjunctive medications are needed for successful treatment because of the complexities of burn pain.
“Nearly half a million burn injuries occur throughout the United States every year,” wrote authors of the study. “Burn injury can produce the most physically debilitating and traumatic injuries due to their systemic effects on the body that can lead to significant morbidity and mortality.”
While 11 million patients around the world experience a burn injury every year, finding successful interventions for its treatment has posed a challenge for researchers and providers alike. The unique and debilitating presentation of pain in burn injuries is another barrier to finding treatment options that are safe and effective.
There are 11 million patients around the world who experience a burn injury every year. | image credit: mlangsen / stock.adobe.com
As the researchers noted,1 “one of the most debilitating aspects one observes during the care of burn injury subjects is the pain that these patients experience from the onset of injury, during the recovery and the rehabilitation period, and in some instances, even beyond full wound healing and hospital discharge.”
READ MORE: Cryotherapy Spray Reduced Pain, Improved Joint Mobility
To further understand BIP, the researchers’ goal was to identify the mechanisms leading to pain as well as the most beneficial and least invasive treatment options. More specifically, they highlighted the role neuro-immune interaction plays in the presentation of pain in patients with burn injuries. They focused on spinal microglia activation as a target for BIP treatment.
Outside of treatments for BIP, microglia activation has also been identified as a target for spinal cord pain treatment. “As the injury advances, microglia undergo activation and secrete pro-inflammatory cytokines, resulting in the emergence of neuropathic pain,” wrote authors of a study published in Experimental Neurology.2 With the complex pathways previously explored in BIP, researchers recommended that its treatment focus on neuropathic and inflammatory pain components.
“Microglia, the resident macrophages of the central nervous system (CNS), together with the peripheral macrophages, comprise the innate immune system. During damage or environmental changes, they respond by transforming and/or migrating to the area of injury,” wrote authors of the current study.1 “Burn injury leads to systemic and neuro-inflammatory responses. Burn injury induces microglial proliferation and activation, together with pain.”
Researchers then moved to BIP treatment and the important role opioids play. Indeed, opioids have been used frequently for the treatment of BIP due to their efficacy and access compared with other analgesic medications. However, since many patients with BIP inevitably require higher and higher doses of opioids, multimodal approaches with pharmacologic and nonpharmacologic agents are crucial to the treatment of BIP.
“Even though opioids continue to be upheld as the mainstay of treatment, a multimodal pain regimen with other non-pharmacologic adjunctive agents is of utmost importance due to the multifaceted nature of BIP,” they continued.1 “This regimen should be all-encompassing and requires a thorough understanding of the anatomic, metabolic, and psychologic factors that encompass this type of pain.”
After exploring background, procedural, breakthrough, postoperative, and chronic pain in the context of burn injuries, they suggested the multimodal approach of treating BIP. The nonpharmacologic agents in conjunction with opioids that researchers suggested for BIP treatment included innovative technologies still being developed for clinical use. Researchers mentioned virtual reality, distraction therapy, hypnosis, and cognitive behavioral therapy as adjunctive approaches to treating BIP.
Researchers outside of BIP exploration are also exploring a plethora of these innovative pain treatments, including virtual reality, wearable technology, artificial intelligence, neuromodulation, and psychedelics.3 With so much investigation into nonpharmacologic agents for treating BIP, patients are receiving an increasingly viable list of options to relieve pain.
“The management of BIP poses a significant challenge for clinicians due to its dynamic and variable nature,” they wrote.1
However, similar to many previous investigations into the treatment of pain, successful BIP treatment can be achieved; it requires a regimented approach with multiple interventions and appropriate provider knowledge of the mechanisms of BIP.
“A diligent approach with close attention to these factors by the health care team can have a significant impact on the patient’s journey from initial injury to the rehabilitation period and can substantially improve long-term outcomes. Future research could focus on nonopioid techniques to manage BIP,” concluded the authors.1
READ MORE: Pain Management Resource Center
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