No abstract

Burn injuries represent a severe form of acute pain. In spite of improvements in wound treatment and pain regimens during recent years, the management of burn pain still remains a common problem and a tremendous challenge for clinical staff. An efficient pain treatment plan contributes to a fast and uneventful course and is an important part of the therapeutic management by plastic surgeons, anesthesiologists, psychologists and physiotherapists. Extensive pharmacokinetic alterations, additional neuropathic components and multiple dressing changes or therapeutic procedures need a flexible and dynamic pain strategy. A standardized continuous pain assessment and documentation are a cornerstone of burn pain control. In addition to pharmacological methods non-pharmacological procedures can play an important role and should be started early during burn patient therapy.

Topical 8 % capsaicin is an established therapeutic option for the treatment of peripheral neuropathic pain. In accordance with the internationally accepted definition, complex regional pain syndrome (CRPS) type II is a form of neuropathic pain so that capsaicin plasters represent a treatment option. However, for the treatment of CRPS it is recommended that painful stimuli should be avoided but capsaicin induces a strong nociceptive stimulation and so its use is at present controversial. We report on the course of such an application in a patient who developed CRPS type II with intractable neuropathic pain after hallux surgery. As a result of a single treatment with capsaicin a pronounced recurrence developed with central nervous symptoms.