BURN PAIN : Evaluation and Management - 11/09/11

Doi : 10.1016/S0889-8537(05)70333-3

Karen J. Kowalske, MD ^a, Darrell L. Tanelian, MD, PhD ^b,^c

^a Departments of Physical Medicine and Rehabilitation (KJK)

^b Anesthesiology and Pain Management (DLT)

^c The Eugene McDermott Center for Pain Management (DLT), The University of Texas Southwestern Medical Center at Dallas, and the Parkland Memorial Hospital, Dallas, Texas

Résumé

Burn injury is one of the most painful conditions an individual may ever experience. Each year in the United States, approximately 1.5 million people suffer a burn injury. ^{4 Brigham PA, McLoughlin E: Piecing together a national burn profile [abstr 104]. In American Burn Association Twenty-Six Annual Meeting, Orlando, 1967

Cliquez ici pour aller à la section Références} Of these, 500,000 people are seen in an emergency department, and more than 50,000 are admitted to the hospital. ^{4 Brigham PA, McLoughlin E: Piecing together a national burn profile [abstr 104]. In American Burn Association Twenty-Six Annual Meeting, Orlando, 1967

Cliquez ici pour aller à la section Références} Approximately 5500 deaths per year are attributed to the complications of burn injury. ^{4 Brigham PA, McLoughlin E: Piecing together a national burn profile [abstr 104]. In American Burn Association Twenty-Six Annual Meeting, Orlando, 1967

Cliquez ici pour aller à la section Références} All of these individuals have pain associated with burn injury.

Minor burn injuries have fewer physiologic consequences but may be equally painful. The pain following a burn is initially related to the magnitude and type of tissue and nerve damage sustained and the resultant inflammatory process (see the articles by Sorkin and Yaksh and Chaplan). In addition, treatment-related pain arises from escharotomies, intravenous line placement, skin graft procedures, and other burn therapy. Pain may be made worse by psychological factors, including fear of pain or disfigurement, anxiety related to loss of control, distress of losing family members or material possessions at the time of the injury, and development of depression. ^{7 Choiniere M., Melzack R., Rondeau J. , et al. The pain of burns: Characteristics and correlates J Trauma 1989 ; 29 : 1531-1539 [cross-ref]

Cliquez ici pour aller à la section Références}

A comprehensive interdisciplinary team approach to management of burn-related pain is essential for maximizing a patient's functional outcome while minimizing psychological distress and facilitating community reentry. A combination of pharmacologic, procedural, physical, and psychological pain-relieving treatments needs to be employed. In addition, the physician needs to recognize and address the special needs of the pediatric burn population.

Le texte complet de cet article est disponible en PDF.

Plan

Address reprint requests to Karen J. Kowalske, MD, Department of Physical Medicine & Rehabilitation, The University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, CS1.104, Dallas, Texas 75235-9055